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Atypical Cushings & Chronic Kidney Disease

Posted by xracers (My Page) on
Thu, Jul 30, 09 at 11:46

Hi,
I'm brand new to iVillage, hope this is the right forum...
My now 5 year old greyhound has Atypical Cushings and Chronic Kidney Disease. Her adrenal testing is done by U of Tenn. She has been on 12mg of Melatonin for about 7 months and it has helped level out some of the hormones. After about 5-6 months I noticed the symptoms returning and another test was sent to U of Tenn. The hormones treated by the Melatonin (estrogen/progesterone) are at a perfect level but now other hormones (NOT Cortisol) are out of wack. Cortisol is NOT involved. We are now adding flax hulls and a small dose of Lysodren 2 days/week. I am wondering if anyone has used this combination and especially Lysodren. And if this condition will impact her length of life. Also, regarding the kidney disease, since this dx Gracee is fed ONLY HILLS K/D. Treats are the K/D kibble. She can have a couple of baby carrots and a small amount of dried papaya each day but nothing else. Do you know anything about the best diet for a young dog with kidney disease? And, is there a connection between these 2 conditions? I'll do whatever it takes for Gracee (and Henry, our other greyhound - see them at their website, xracers.net) Thank you very much in advance.
Lisa
Gracee & Henry (xracers)
www.xracers.net

Here is a link that might be useful: Gracee & Henry - Adopt A Greyhound :-)


Follow-Up Postings:

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RE: Atypical Cushings & Chronic Kidney Disease

What are the symptoms of Cushings that were not attributable to kidney disease?


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RE: Atypical Cushings & Chronic Kidney Disease

Hi, Thank you for the quick response...

Gracee was drinking far too much water and peeing like crazy, having accidents and she was instantly a well housebroken dog from the day I brought her home from the adoption kennel. I this increase in drinking and having accidents took place over a long period of time during which I was dealing with my dying father and would bring urine samples to my regular vet and have blood drawn and everything was fine so I put off seeing the specialist as was recommended. So the drinking and peeing got worse and worse, my personal situation changed freeing me up to take Gracee to the specialist.

Initially, Gracee had a bacterial kidney infection dx'd after casts, and growth on a culture in addition to elevated bun/creat. and inability to concentrate urine. Also, changes shown on kidneys in ultrasound. I have been taking Gracee to a specialist who is an hour north of us and he suggested running an adrenal panel as well as the tests that he could not run in house - the culture - before coming to any final decisions. We left with instructions to feed ONLY KD and waited for culture results and adrenal results from Tenn. before starting any other treatment. The culture came back positive for bacterial infection and Gracee was on antibiotics for 2 months. Upon recheck at local vet, the infection was gone. 2 weeks after initial visit to specialist, results from Tenn. of the adrenal testing showed over production of estrogen and progesterone and Melatonin was the remedy of choice. Gracee had very little hair, she was very bald, and now, 5-6 months after starting the melatonin, she is very hairy. I show this change on my website, www.xracers.net and until recently, she has been drinking and peeing normally.

She started drinking and peeing too much again and we saw the specialist. Her kidneys she no infection (culture came back normal), she has no casts to speak of. She is not concentrating her urine and her bun is elevated (Greyhounds have different "normal" values than other dogs like a Lab.) Dr. Lyman wanted to send out another adrenal panel, he had planned on rechecking the values even if she had not begun to drink/pee too much again. The adrenal values came back high, NOT the Cortisol and NOT the estrogen/progesterone.

I am very sorry this is so long. I guess the short answer is that from what I can tell, other than the hair, the symptoms are the same.


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RE: Atypical Cushings & Chronic Kidney Disease

I have two cushingoid dogs and one has pituitary dependent cushing's with elevation of all adrenal steroids/sex hormones. I guess you could say she has both typical and atypical cushing's. Both of my dogs are being treated with Lysodren and the one with elevated intermediate hormones also takes melatonin and pressed flaxhulls. I suspect that if Gracee is strictly atypical, you are using a maintenance dose of Lysodren, right? Lysodren is effective in controlling the intermediate sex hormones; however, it may not be effective in reducing estradiol as this hormone can be found in bodily tissues outside of the adrenal glands.

The vast majority of dogs with cushing's have increased protein in their urine. This is secondary to cushing's and not indicative of kidney dysfunction. As for diet, check out http://dogaware.com/kidney.html There is some great information there on kidney disease and appropriate kidney diets.

We have a great support system for pet owners with cushingoid dogs at www.k9cushings.com and I highly recommend that you check it out and consider joining. There is a wealth of information there and a ton of collective knowledge that members won't hesitate to share with you. It's a frustrating disease and it's much easier to handle if you have someone to talk to that knows exactly what you are going through.

I noticed that caninecushings.net was mentioned in a prior post so I want to let you and everyone else know that caninecushings.net was taken offline by the owner suddenly and without reason a number of months ago. The moderators and administrators are now at their new home, k9cushings.com.


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RE: Atypical Cushings & Chronic Kidney Disease

Assuming the correct diagnoses, a dog with chronic renal disease showing azotemia (high BUN and/or creatinine) has already lost 75% of renal function. A non-azotemic dog with low urine specific gravity has lost 66% of renal function, IF that specific gravity is 100% caused by the renal disease. Unfortunately, having lost that much renal function does shorten a dog's life.

The 2 diseases aren't really related as far as cause, but they can have devastating effects on each other. Factors that increase morbidity in renal disease are hypertension, proteinuria, hyperphosphatemia. Proteinuria is an effect of kidney disease, but it also causes further kidney damage. Proteinuria is also an effect of Cushings, which of course also aggravates the renal disease. A low protein diet is necessary to decrease the amount of protein going to the kidneys, and therefore reduces the damage. Cushings can also cause hypertension, which damages the kidneys. And in typical cushings, you increase the risk for diabetes mellitus which can also cause kidney damage. So lots of intertwining effects on both of those diseases. Having both also makes diagnosis and management a challenge as it's difficult to know if the symptoms are caused by lack of management on the renal issue or lack of management on the cushings issue. No easy way to sort that out.

Now all that is based on your typical hyperadrenocorticism, not atypical cushings. I don't know that anyone knows enough about atypical cushings to make any correlations.

My major concern is adding lysodren to a dog with pre-existing renal disease. That may be a dangerous combo, especially when lysodren isn't used for atypical cushings. If there were some clear indication for it, I might play that game. But the cortisol is not high then I can't think of a good reason to play in that neck of the woods without clear indication. Especially if the medication isn't controlling the symptoms which may be all due to worsening kidney disease (which is made even worse with the lysodren).

The diet recommendations for kidney disease are based on monitoring proteinuria, hyperphosphatemia, hypertension, and other parameters. In some cases, all the dog needs is a quality senior diet. Some vets prefer a heart diet such as H/D with its moderate protein restriction as opposed to K/D. Others go with the Purina renal formula. Treating proteinuria specifically usually requires an ACE inhibitor such as enalapril or benazapril. Sometimes the ACE inhibitor is also enough to treat hypertension, other times you need to add amlopidine or other medication. Lots of things can be affected by both diseases, and frequent monitoring and adjusting the treatment protocol is warranted. Oh, and both diseases predispose dogs to UTIs, so routine urine cultures are also needed.

Hope that helps a bit. It's probably as confusing to you as it is to me and anyone else who reads it. But you unfortunately have an interesting case in your Gracie. I hope things can be worked out best for her.


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