Elevated Liver Enzymes and BNP in 12 yo Setter

[Ceffyl_Dwr]

…there are elevations in her liver enzymes (ALT is at 127, normal range 18-121. ALKP is at 1086, normal range is 5-160) and cardio pro BNP( is at 1004, normal range is 0-900). The rest of her blood values are normal. Causes of elevated liver enzymes could include, infection, inflammation, auto-immune, copper storage disease, toxin, metabolic disease (like Cushings), neoplasia, or idiopathic. Further work up would include ultrasound of the heart and abdomen and/or radiographs of the chest and abdomen to screen for any evidence of cancer vs condition that can be managed medically.

Hello, fellow dog owners. Has anyone had a similar diagnosis? What did you do? I’m in the research phase at this point. She’s a gray faced older lady, but she eats, chases the ball, and still loves a hike (though at a slower pace these days).

[volvo_240]

Has she had a urinalysis? If not she needs that before I’d move forward with additional diagnostics.

What kind, if any, clinical symptoms does she have?

[Ceffyl_Dwr]

Thanks for responding. She is nine pounds lighter than she was at her last visit roughly nine months ago. Other than slowing down with age, I haven’t noticed changes in eating, drinking, or coat condition.

She does have a couple of teeth that one vet recommended pulling. Another said they were fine to leave in until they affected her eating. They haven’t.

I’m still researching next steps, and I’m torn. Should my next step be an ultrasound, a biopsy, an x-ray, or Denamarin for the liver and rechecking in a couple of months (taking into consideration potential heart disease)?

The irony that I recently took a visit to the breeder who I adopted her from and she remarked how great she looked for 12 is not lost on me. In the end, it’s just never enough time and tough decisions never get easier.

[pick_a_pony]

My old girl (labx) had elevated liver enzymes and we decided that Denamarin was the extent of what we were going to do. Ours was about the same age if I remember correctly. She lived a few more good years until the sudden onset of lupus was what really did her in. She had an abscessed tooth that she went under for removal and with it her first and last dental of her life. The pre op blood work was when we saw the elevated liver numbers. We felt that at her age doing more wasn’t the right choice as something most likely cancer would get her eventually and making her uncomfortable with anything above and beyond wasn’t the route we wanted to go.

[volvo_240]

Lack of symptoms makes Cushings a little less likely to me - they basically act like they are on prednisone. However it’s possible to not really notice when it’s a gradual change.

If finances aren’t a huge concern I’d do an ultrasound, ideally both abdomen and chest. It’s non invasive and will give you better information to make decisions about how/what/if to treat. Otherwise you will likely find yourself playing ‘what if?’ as time goes on.

ETA not a vet but after 15 years as a tech/hospital manager I love playing one on the internet

[Simkie]

I agree with the ultrasound recommendation, even if you have no interest in pursuing anything invasive. Just knowing what might be going on in there can help inform your path forward & what warning signs to watch for, so you can make better decisions for her as she nears the end of her life.

She’s just a lovely lady, what a pretty face she has.

[Leather]

@Ceffyl_Dwr

She does have a couple of teeth that one vet recommended pulling. Another said they were fine to leave in until they affected her eating. They haven’t.

Based on experience with my own dental issues, there can be a significant amount of pain that doesn’t impact the ability to eat. When I had my problem tooth removed I realized that I’d had a headache for the last 6 months and just generally felt crappy - I hadn’t realized how much it was impacting me. It’s a balancing act between the risk of anesthesia and her age/health, but she may be fairly uncomfortable and not showing it.

The ultrasound sounds like a good starting place.

As mentioned usually Cushing’s is symptomatic, but she could possibly be early stage Cushing’s and not yet symptomatic - that’s what happened with our 10 year old lab. We had put her on NSAIDs for arthritis and her monitoring bloodwork came back with elevated ALT/ALP. We switched them around a few times thinking she was maybe just not handling a particular drug well and her levels fluctuated but never went back to normal.

After about 6 months she started to develop clinical symptoms (polydipsia, muscle loss, thinning coat) so we pursued testing for Cushing’s. Long story short she had an adrenal tumor causing the Cushing’s and a mass on her liver (50% of the adrenal tumors are malignant).

But even with Cushing’s it’s about managing symptoms and not really treating/curing. When her symptoms got worse (incontinence, polyphagia, panting/restlessness) we put her on a low dose trilostane regimen and she did well on it. There’s really not much to do if they aren’t symptomatic.