What is going on?

Re: What is going on?

Stephen Courtney — Wed, 18 Jun 2014 23:20:22 GMT

As frustrating as this is, if the dog is otherwise well then it is not immediately life threatening. i think the comment about medullary washout is pertinent, and remember there are degrees of cushings, and as time goes by the pituitary microadenomas grow. So while your baseline bloods may not be typical of a de novo case, the dog may still have a raised ACTH stim response.You do get increased protein metabolism ( catabolism) with cushings and this can increase the creatine and urea, but as mentioned above perhaps medullary washout has reduced the urea levels?

Might be an idea to send an email to Prof Ramsey at Glasgow, he is very helpful and he is Dr Cushings after all!

Re: What is going on?

Claire Fisher — Wed, 18 Jun 2014 21:23:46 GMT

[quote user="Sarah Keir"]

Can't do an ACTH stim as no synathen and DECHRA are being very slow in sending a replacement.

Also no supporting evidence on bloods for Cushings being out of control - Alk Phos well within normal (and has been since a year after first diagnosis), no stress leukogram, cholesterol normal.

I am beginning to think psycogenic as his owner tells me he has always drunk more than would expect and went up when diagnosed cushings and never came down again.

So why increased creatinine and normal urea?

[/quote]

Could medullary washout be affecting urea and keeping it WNL?

I would look for protein in his urine - preferably with a UPC as its so dilute and check his BP as well while waiting for the synacthen to arrive.

Re: What is going on?

Sarah Keir — Wed, 18 Jun 2014 20:59:52 GMT

Can't do an ACTH stim as no synathen and DECHRA are being very slow in sending a replacement.

Also no supporting evidence on bloods for Cushings being out of control - Alk Phos well within normal (and has been since a year after first diagnosis), no stress leukogram, cholesterol normal.

I am beginning to think psycogenic as his owner tells me he has always drunk more than would expect and went up when diagnosed cushings and never came down again.

So why increased creatinine and normal urea?

Re: What is going on?

Stephen Courtney — Wed, 18 Jun 2014 17:50:59 GMT

I think you need to repeat his ACTH stim test - you have ruled out all the other causes of hyposthenuria except psychogenic, and you can't really be sure about that with a Cushings dog.

Hyposthenuria implies adequate renal tubular activity so kidney issues are not the answer., so DI very unlikely in my opinion.

I'd blame the Cushings!