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Dr.Caroline
Dr.Caroline, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 643
Experience:  DVM for 20 years, cat and dog general practice, emergency work, holistic medicine
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My dog has elevated ALT/AST/ALK Phos. enzymes. BUN and Creatinine

Resolved Question:

My dog has elevated ALT/AST/ALK Phos. enzymes. BUN and Creatinine are normal. A specialized test called a GFR was done on her and the results came back at 5.03 mL/min/kg, range was 2.89 - 8.07 mL/min/kg, "well within the canine reference range". I am confused are these liver or kidney specific tests? Should we be focusing on liver disease or kidney disease?
Submitted: 5 years ago.
Category: Dog Veterinary
Expert:  Dr.Caroline replied 5 years ago.

Hi,

Thank you for asking your question on JustAnswer. The other Experts and I are working on your answer. By the way, it would help us to know:
-Do you have the exact blood test results?

-Was there a urine analysis done?

-If so, what are the results?

-Is there any symptoms?

-If so, which ones?

-I do not see your dog's age, sex and breed, what are they?

Thank you again for trusting us with your problem. Please reply as soon as possible so that we can finish answering your question.

Customer: replied 5 years ago.

My dog is a female, age 8.

 

In looking at the test results, here are some numbers, I hope they help.

 

AST - 102 H

ALT - 208 H

ALkaline Phosphatase - 195 H

Magnesium - 1.3 L

 

Urinaylsis 1.011 L

Billirubin Trace H

Microalbuminuria - 3.7 H

Everything else was in normal range on that test

 

Another Test was called a Urine Protein/Creatinine Ratio

 

Protein 26 Normal

Creatinine 91 Normal

Urine/Proetein Creatinine Ratio 0.3 Normal

 

Symptoms - Severally confused, almost like she has blindness, thirst, stomach upset

Expert:  Dr.Caroline replied 5 years ago.

Hi,

thanks for the results!!! Awesome information

Let me know what is the normal range for the liver enzymes for the lab your primary care veterinarian is using.

Those liver values at first glance looked pretty good actually, but let me know the lab range.

Was the CBC (complete blood count) normal?

Were the retinas looked at?

Any blood pressure taken?

Was there any other tests run then the ones you mentioned?

Do you have an albumin level (with normal range).

 

Definitely not a normal urine concentration!

Do you see her urinate a lot more then usual?

When you mention stomach upset, what is she doing?

 

Is she spayed?

 

Any change in her abdomen shape?

Any urinary infections in the last few years?

Any change in her skin, any skin infections?

Any hair loss?

 

Let me know.

 

In the meanwhile, here is a link on laboratory results and what they may mean:

http://www.vetmed.wsu.edu/ClientED/lab.aspx

 

Customer: replied 5 years ago.

AST 102 Lab Range 15 -66

ALT 208 Lab Range 12 - 118

(ALT has been taken before and has been as high as 412)

Akaline/Phosp 195 Lab Range 5 - 131

 

These counts are in the high range on past test also.

 

Albumin 3.3 Lab Range 2.7 - 4.4

 

CBC - Everything in this section was in normal range

 

I was told she had high blood pressure.

 

She is urinating alot and her stomach upset is that seems to almost heave and be trying to vomit.

 

She is very confused.

Expert:  Dr.Caroline replied 5 years ago.

Hi,

is she on any medications for the high blood pressure?

Do you remember what was her blood pressure?

Is she on any medications right now? Any supplements?

 

Bear with me, we're almost there!

 

Customer: replied 5 years ago.

She is not on any meds, b/p or other at this time. I brought her in on an emergency basis for the confusion and that is when they told me her b/p was high, I think around 200? and they said she was probably stressed.

 

I am really trying to understand these high blood counts and what they are specific for, liver or kidney? Do these counts and symptoms indicate liver or kidney disease?

Expert:  Dr.Caroline replied 5 years ago.

The ALT, AST are more liver oriented. AST can mean muscle damage (you would have a CPK high too) and those values gets extremely high in this case

 

As for the ALKP, there are several isoenzymes tested by this one, and it can mean:

cholestasis which is bile retention from liver enlargement, obstructions of other causes. This causes if very severe an increase in bilirubin (bile pigment).

 

BUN and Creatinine will go up when significant damage to the kidney occur, or if the dog is very dehydrated.

 

All the enzymes values are not too significant. To be taken in account, those values need to be 2 to 3 times the high normal. As you can see those are not too high. the ALT can increase from a lot of different causes not only liver disease. If high (like the 412) with no symptoms, it is something i would follow up.

 

Now, if you have liver failure, you may have disorientation, not acting right. And your liver enzymes could be normal or not. Usually if severe enough, you have other changes in the blood work.

 

What is really of concern is also her drinking a lot, 1.011 of urine concentration is basically what we call isosthenuric, so not concentrated. Since your dog had microalbuminemia and low urine specific gravity and possibly high blood pressure, it might be why you got a GFR done.

 

Since I do not see your dog, I can not tell you what should be done next, but I can make some recommendations. I hope this can open a line of communication with your primary care veterinarian.

 

Since we have increase water intake (polydipsia), mild liver enzymes increase , abnormal behavior, let's see what the different causes we can come up too:

 

-Hyperadrenocorticsm: I know she might have been stressed at the ER, but 200 is pretty high, I would do this again at your primary care veterinarian. High blood pressure is present in this disease. Symptoms can be different from one dog to another. Drinking a lot is a classic symptom. There are tests to determine if dogs have this disease:

http://www.veterinarypartner.com/Content.plx?P=A&C=&A=635&SourceID=

Make sure you add the = to the end of the link when you copy it. I am not able to add the = sign into the link for you to just click on it.

 

-Kidney disease: well, does not seem like it, but would encourage to have a culture done and do another microalbumine test (you can see values much higher). Microalbuminuria can be caused by high blood pressure, gastrointestinal loss too.

 

-Liver failure: still worth doing some bile acids tests to test the liver function.

 

-Other causes for polyuria:

ADH (antidiuretic hormone) deficiency: idiopathic, traumatic, neoplastic, or congenital origin central diabetes insipidus

Primary polydipsia: behavioral problem, organic disease of the anterior hypothalamic thirst center of neoplastic, traumatic, and inflammatory origin, pyrexia, and pain.

 

Possibly an abdominal radiographs, an abdominal ultrasound might be necessary. A Modified Water Deprivation with Antidiuretic Hormone might be necessary. Sometimes if all else fails, a MRI and A CSF tap might be run.

 

Let me know if you have more questions, or need additional information.

If this is helpful, do not forget to select the ACCEPT button.

 

Customer: replied 5 years ago.

I appreciate your suggestions, however, I am still confused by all the tests that were done. I am trying to make sense of all the testing that has been done.

 

Am I understanding these tests correctly.......The AST/ALT/ALK PHOSP tests are liver related enzymes/test, is this correct? (CPK was not high)

 

BUN/Creatinine are kidney related enzymes or tests, is this correct?

 

The GFR test is a kidney related test, is this correct?

 

If BUN/Creatinine/GFR tests come back within normal range wouldn't that indicate normal kidney function or that disease of the kidneys was not likley present?

 

Do the test results I gave you point towards liver or kidney issues?

 

 

 

Expert:  Dr.Caroline replied 5 years ago.

"Am I understanding these tests correctly.......The AST/ALT/ALK PHOSP tests are liver related enzymes/test, is this correct?"

Yes but they are not that high, and it may not be liver related or normal for her.And the increased ALKP could also form Cushing disease

 

 

"BUN/Creatinine are kidney related enzymes or tests, is this correct?" Yes, but BUN can be associated with other problems if not normal. It needs to be interpreted with the urine specific gravity.

 

"The GFR test is a kidney related test, is this correct? "They test the glomerular function of the kidney, which is a part of the nephron function.

 

"If BUN/Creatinine/GFR tests come back within normal range wouldn't that indicate normal kidney function or that disease of the kidneys was not likely present?"

I would start chasing something else then kidneys mainly because of the disorientation signs. But I would still check her blood pressure again , recheck the microalbumine level, and do a urine culture. You can have kidney infections with little symptoms.

 

"Do the test results I gave you point towards liver or kidney issues?"

Tests results need to be read as a whole picture: physical examination, the whole blood tests values, the history of the dog, past tests, which I do not have.The kidneys looks fine to me, but I cannot tell about the liver. There might be no liver problem at all, liver might be part of the problem, or the liver is the problem.

 

I encourage you to discuss with your primary care veterinarian about what is next for your dog. Veterinarians can work medical cases differently depending what they have available to them and their training.

 

Things to possibly discuss:

Retinas examination

Blood pressure

Cushing tests

Bile acids test

Urine culture

Abdominal radiographs/abdominal ultrasound

Modified water deprivation test

MRI, CSF tap

Customer: replied 5 years ago.

I hope this reply might be helpful and save you time in the future in answering other individuals questions. I am not sending this to be critical of you or your opinion, really just hoping it saves you time and helps you with future questions.

 

It may be helpful for you to know, that in my opinion my questions were not answered, you asked more questions and offered suggestions, I was not asking you to diagnose my dog or for what "could be". I am sure in most cases individuals are asking for that, but my questions were clearly specific testing questions.

 

My dog was diagnosed with kidney disease, which I am questioning. That is why it is imperative for me to know which enzymes are liver/kidney specific.

 

I asked very standard veterinary bloodwork specific questions that could had been answered in probably 1 -2 sentences each.

 

I have done further research to answer my own questions and that research indicates ALT/AST/ALK, especially when combined highs e.g. ALT/AST in dogs are liver related and are present in liver disease/disorders. With abnormal urine concentration present in addition to the elevated ALT/AST this is a strong indication the liver is not functioning properly.

 

The results that you asked for and I gave you were 2 x normal (and past tests had been as high as 4 x normal), so in your own words "this should be taken into account", but was not taken into account by you when stating the values were not very high?

 

I have done further research to also find BUN/Creatinine and GFR are kidney specific tests.

 

I also answered my last question, with completely normal kidney testing, and abdormal liver testing we should clearly be focused on liver disease/disorders, not kidney disease.

 

I realize you must be careful with what you say, but this is general factual medical information.

 

I am bringing this to your attention because it was not necessary to bring my dog's history into play in answering what were general medical bloodwork questions. I realize that overall exam, history, etc. play a part in diagnosing a dog, I was not asking you to diagnose my dog or even speculate what could be.

 

As I appreciate your overall thoughts, I really was just looking for answers to my bloodwork specific questions.

 

I would appreciate an acknowlegment to this reply and I will gladly click accept after that reply so you can get paid. Although my specific questions were not really answered and I had to do research on my own, I appreciate your effort.

 

Thanks.

Expert:  Dr.Caroline replied 5 years ago.

Hi,

thank you for the comments. I do see where you are coming form, and that is true you did not ask me to make a diagnostic. However, it is very hard to make comments on only some tests results. For example a dog with a high ALKP like 800 could be totally normal, as another one could be sick and have severe gall bladder obstruction, or severe liver disease, or Cushing disease. As I mentioned, the whole picture has to be taken in account: dog physical examination, other tests if done, past history. Liver enzymes increase can be liver specific or not. The liver may be implicated or reacting to something else in the body (infection, tumor, sometimes we find nothing not even associated with the liver). I did mention I would look for something else then the kidneys. Maybe I should have been more clear about looking for something else then primary kidney disease. The microalbuminuria could be indicative of nothing or another process affecting the kidneys. I just like to be thorough, and help out as much as I can. Sorry if I went overboard, just trying to make you look at those liver enzymes as just not necessary liver specific disease.

Sincerely.

Hope everything turns out well, keep me posted.

 

Please, you do not have to accept this answer if this did not represent what you were looking for.

 

Let me know if you have more questions.

Customer: replied 5 years ago.

Thank you for your reply.

 

I would like to take another stab at asking you this question.

 

If a dog's ALT/AST/ALK PHOS (all 3) were chroncially elevated with every blood test, and urine concentration was abnormal, would you be focused on diagnosing liver disease?

Expert:  Dr.Caroline replied 5 years ago.

Hi,

the answer is yes and no

I would make sure part of my work up would include tests that would help know if I am dealing with a priXXXXX XXXXXver problem (liver inflammation/infection/cancer) or if the liver is reacting to a another problem (pancreatitis, cushing disease, cancer not primary to the liver, others).

 

Dr.Caroline, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 643
Experience: DVM for 20 years, cat and dog general practice, emergency work, holistic medicine
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