My doggie has been on treatment for cushings - Brownie has passed

[Marce]

It's been a while since I posted here. Brownie has been pretty much stable with Trilostane. This week she has been very lethargic, not wanting to walk when taken outside. Yesterday she started throwing up multiple times, and had diarrhea. Got some labs done and this is what I got back:

https://i.imgur.com/XtPLdGI.jpg

Notice her Creatinine levels. Last labs done Oct 2015 had her at 1.7. Now she is at 7.2. Now I fear she is experiencing Acute Kidney Failure. The vet tells me that it is weird that her creatinine levels would spike like that if she was fine before, and that if she was experiencing Stage 4 Kindey Failure like this she would be in a worse off shape, and so thinks its a lab failure, and so wants to re-test her Monday.

Have any of you guys had experience with this? I know Trilostane elevates Creatinine levels, could this be due to this and if we stop administering it might go down? Or should I prepare to say goodbye to her?

[Marce]

It's been a while since I posted here. Brownie has been pretty much stable with Trilostane. This week she has been very lethargic, not wanting to walk when taken outside. Yesterday she started throwing up multiple times, and had diarrhea. Got some labs done and this is what I got back:

https://i.imgur.com/XtPLdGI.jpg

Notice her Creatinine levels. Last labs done Oct 2015 had her at 1.7. Now she is at 7.2. Now I fear she is experiencing Acute Kidney Failure. The vet tells me that it is weird that her creatinine levels would spike like that if she was fine before, and that if she was experiencing Stage 4 Kindey Failure like this she would be in a worse off shape, and so thinks its a lab failure, and so wants to re-test her Monday.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post asking about kidney failure into your baby's original thread. We like to keep all the history about each pup in one place so it is easier to look back thru the history. Thanks!

[Harley PoMMom]

That upward spike in the creatinine is worrisome. Has the vet mentioned having IDEXX SDMA kidney test performed? I also see her glucose is elevated and her WBC also, did the vet say anything about those two levels? Is her phosphorus elevated?

I'm including a link with info regarding that IDEXX SDMA test: https://www.idexx.com/small-animal-h...with-sdma.html

Hugs, Lori

[labblab]

Marce, I'm sorry to say that with the combination of letheragy, vomiting, and diarrhea alongside very highly elevated BUN and creatinine, I'm afraid Brownie is truly experiencing kidney failure. I don't think this sounds like a simple lab error. If she is lethargic, vomiting, and has diarrhea, why is your vet saying that she doesn't seem to be very sick???? Those symptoms are classic for renal failure.

If her creatinine and BUN are truly this elevated, her body is being overwhelmed by a toxic overload that has to be relieved, I believe, by IV therapy. Other blood chemistries may also be quite imbalanced, as well, and in need of treatment.

If these results are genuine, I'm afraid that Brownie is only going to worsen and perhaps quite rapidly. How is she doing now?

Marianne

[Marce]

Thank you for your responses. I am very worried. She was not eating or drinking or peeing over the weekend, then on monday they gave her fluids and gave her a corticoid, and she bounced back that night. Started eating again, and drinking, and vomiting and lethargy stopped and she kinda looks like she's back to her old self since then. I was hoping it was Addisson's. Her cortisol was down to 1 (she takes trilostane) maybe it has been even lower for a while now without me noticing.

Took another biochemistry test 4 days after the previus one and her BUN shot up to 160 from 103 (maybe cause she was only wanting to eat meat for the couple of days after her apetite stopped) but oddly her Creatinine went down from 7.2 to 5.7. How can this be, is this normal?

This is the result of her electrolytes test, her phosphorous is elevated.

CLORO : 116.5 mEq/L ( 110.0 – 124.0 mEq/L )
POTASIUM : 5.2 mEq/L ( 3.9 – 5.1 mEq/L )
SODIUM : 178.9 mEq/L ( 140.0 – 152.0 mEq/L )
PHOS : 14.5 mg/dl (1.9 – 7.9 mg/dl )
CALCIUM : 8.26 mg/dl (9.0 - 10.8 mg/dl)

I also put together some of her lab history in excel and chart form. From 2012 - 2013 her cortisol was going up and down trying to find the right dosage of trilostane for her. Red is elevated values.

https://i.imgur.com/TuY9j4T.png

Thank you again for your responses.

[Marce]

Whatever it was it seems to have been temporary. Her Cretinine is down to 2.88 and her BUN to 50. She seems to be getter better, im thinking it was the Trilostane.

[molly muffin]

I am so glad to hard she is doing better and that the creatinine has come down. Is she eating, drinking and everything okay now too?

[Harley PoMMom]

The elevated phosphorus can make a dog feel very nauseated, when the phosphorus is high a binder is needed.

[labblab]

You know, it may well be the case that she was overdosing on the trilostane. I keep forgetting that elevated creatinine and BUN can accompany an Addisonian crisis and lead to an initial misdiagnosis of kidney failure.

[During Addisonian crisis] The blood panel will come back showing elevations in the renal parameters (BUN and creatinine) and thus with the elevated potassium is suggestive of acute renal failure, a condition with an extremely poor prognosis. The veterinarian may become suspicious of another diagnosis as the patient will respond well to fluid administration and most renal failure patients do not respond as well.

.
In combination with the lethargy, vomiting, and diarrhea, an Addisonian crisis is certainly a possibility. The fact that Brownie has rebounded so nicely while off the trilostane surely does make it seem as though overdosing was the culprit. I would be very cautious about starting Brownie back on trilostane until you actually see reemergence of overt Cushing's symptoms and even then, certainly at a lower dose.

Marianne