How do vets know if it's kidney disease or Cushing's in my pet?

Cushing's or Hyperadrenocorticism is a fairly common endocrine disease in dogs. It can be caused by a bit of overactive tissue in the brain (in the pituitary gland, which is the master ruler of hormone secretion in the body) or a mass in an adrenal gland (sits by the kidneys, secretes hormones as directed by the pituitary gland). Basically what happens is an excess of a hormone in the body, usually a steroid called cortisol, if it is traditional Cushing's. This then causes some symptoms in the pet, blood work changes, and sometimes other changes like high blood pressure. I suspect based on the value that you report that this was a liver enzyme elevation call ALP. This very commonly occurs in pets that have Cushings, but is not specific for Cushing's and elevation can be caused by other disease processes. This value does not correlate with severity of disease as many dogs have a high value. It sounds like your vet is on the right track by recommending an ultrasound to look at the adrenal glands and also the rest of the abdominal organs to rule out other disease processes. Ultimately Cushing's Disease has to be diagnosed by some sort of endocrine testing which your vet may recommend as well. Treatment if then based on what type of Cushing's disease is present. I hope this helps and thank you for using Petco Pet Education Center, formerly Petcoach!

Poor Nemesis. Sometimes pets will need the medication adjusted. I recommend to call your veterinarian and ask if another test is needed to evaluate the blood levels in his body. The test is called an ACTH stimulation test. It has been found that 50% of dogs with Cushing’s disease will also have a urinary tract infection that can only be detected with a urine culture. I recommend to have this test done as well as this will cause constant drinking and urination. Other conditions such as thyroid disease, diabetes or kidney disease can also cause these signs. You must start ruling them out. Best of luck.

I'm sorry that Miller is not feeling well. We certainly see an increase in ALKP as an early sign of Cushing's disease, but ALT is not as commonly elevated. I am attaching a handout with more information about Cushing's disease below. https://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1551 The most common test that we will use to diagnose Cushing's disease is called a Low Dose Dexamethasone Suppression Test. I am attaching a handout below that discusses the specific tests we use for Cushing's disease. https://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=636 However, an abdominal ultrasound is also an excellent test to evaluate the adrenal glands to look for evidence of Cushing's disease. So, I would discuss with your veterinarian if they would recommend doing further blood testing first or an abdominal ultrasound. That answer will likely depend on what Miler's lab work looks like when it is rechecked in 2 weeks. Good luck! I hope that was helpful and you can figure out what is going on with Miller. Thanks for using PetCoach.

Thank you for using Petco Pet Education Center, formerly Petcoach. I'm so sorry to hear Smudge was diagnosed with kidney issues. Unfortunately, a complete blood chemistry panel that includes a urinalysis is very accurate for kidney disease. If you have concerns about Smudge's diagnosis, I would recommend you reach out to Smudge's veterinarian to discuss what the findings were, and what steps may need to be taken. Good luck.

Unfortunately, that's just the nature of some diagnostic tests - they don't always give a clear answer, just like in humans. So repeated testing over the course of a few months, or retesting with a different type of test, may be needed to get a diagnosis. Cushing's disease is notoriously hard to diagonse in many dogs, because the testing is often borderline or inconclusive.

An enlarged liver is unfortunately one of the common side effects of Cushing's disease so it is not unusual that Ginger's liver appeared enlarged. Her urine concentration is very low (normal for a dog is 1.040) but again, this can be attributed to her Cushing's disease as well (because she is probably drinking more water and therefore causing her urine to be more dilute). In Ginger's case I would be worried about Diabetes and possibly cancer as well. I know it can be frustrating (and expensive) to keep doing more tests, especially when you aren't getting clear answers as to what is going on. I would recommend talking to your vet about costs/additional testing versus palliative care/keeping her comfortable for the time being. It may also be worth beginning treatment for her Cushing's disease because it could help allieviate some of her symptoms. Good luck. Please let us know if you have more questions/concerns.

Hi there. It would help to know what specific tests have been done so far. The most common test used to diagnose Cushing's disease is called a low-dose dexamethasone suppression test (LDDST), but an ACTH stim test or urine cortisol/creatinine ratio can also be used in some cases, especially if initial LDDST results are inconclusive. I'm not sure what was found on her ultrasound exams, so I can't comment on that without more information. But if she hasn't had an ultrasound done by a board-certified radiologist, this would be a reasonable next step to consider. Since getting a diagnosis has been such a challenge for your pup, I would consider requesting referral to an internal medicine specialist at this point. He/she can evaluate Hanz, go over all of his previous testing and lab results in detail, and help you determine the best way forward from here.