RE: What would you do in the case of high proteinuria in well controlled Cushinoid dog?

Mellora Sharman — Thu, 02 Nov 2023 09:44:08 GMT

Hi Laura,

A decision around changing trilostane dosage would for me be based upon a combination of pre-pill cortisol AND clinical signs. If there was a suggestion of ongoing poor control / loss of control in the second half of the day, then additional testing may be warranted, but a pre-pill cortisol in the range given, AND absence of ongoing clinical signs of Cushing's Syndrome perhaps would not support an increase in dose.

With that in mind it might be pertinent to ensure we have checked off other causes of proteinuria - the ACVIM Consensus Statement contains a nice little check list for differentials for proteinuria and you can find this here and take a look through to see if any additional conditions are possible and worthy of separate diagnostic investigation --> https://onlinelibrary.wiley.com/doi/10.1111/jvim.12223 . Diagnostics include a range of testing up to and including renal biopsy which could be considered here - this is always best performed before renal disease is documented if the owners will consider this.

As Dr Ian Ramsey suggested in the linked post courtesy of Rob on this thread - if treatment for Cushing's Syndrome has been for >3-6 months, signs are currently considered well controlled and we are not suspicious of any other contributors to proteinuria then non-specific therapy could be implemented. Current recommendations are for an ARB (telmisartan) over an ACE-I for managing proteinuria as per updated guidance from the IRIS Group - so you could consider telmisartan,and this may also be helpful for hypertension (current hypertension guidance remains to start with an ACE-I over an ARB, but overall I'd go with telmisartan initially at least in a case such as described).

I hope this helps!

Best Wishes,

Mellora

RE: What would you do in the case of high proteinuria in well controlled Cushinoid dog?

Laura Dell'Abate — Thu, 02 Nov 2023 08:56:24 GMT

Thank you very much . I have had a look at the post. This dog in particular has been stable for over 2 years. I probably need to add telmisartan then . Thank you for replying !

RE: What would you do in the case of high proteinuria in well controlled Cushinoid dog?

Arlo Guthrie — Thu, 02 Nov 2023 08:26:41 GMT

Rob Loxley - unfortunately that post you've linked to above is in the SAMSOC forum which is only open to members.

Let's see if I can rustle up some other contributions!

RE: What would you do in the case of high proteinuria in well controlled Cushinoid dog?

Rob Loxley — Wed, 01 Nov 2023 22:22:30 GMT

How long we’ll controlled for; Look for a recent post from Ian Ramsey www.vetsurgeon.org/.../13-y-o-mn-sbt-with-cushings-and-proteinuria---acei-or-not