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What
Blood Work Should I Get On My Alaskan Klee Kai?
Laboratory
Values and What They Mean
Owners
and breeders of Alaskan Klee Kai are interested
in assuring that their dogs are healthy. Unfortunately,
these little dogs cannot tell us when they are sick
or have some disease or infection present in their
bodies. But laboratory studies, and sometimes
symptoms can alert the owner to the presence of
a potential health problem. Questions
have arisen from AKKAOA members, and other AKK owners
as to what blood work should be routinely measured
on the Alaskan Klee Kai and what do the different
values really mean? Of concern to some AKK
people is liver disease, specifically, elevated
ALT. Some owners have raised questions about
the occurrence of thyroid disease, as well as questions
about the potential for kidney disease in the Alaskan
Klee Kai. These are all good questions. Concerned
AKK owners have reported these disease states on
the electronic talk boards. However, at this
point in time, we do not know how frequently these
conditions do appear in the Alaskan Klee Kai. That
is why it is so important to determine if there
is a potential health problem in the AKK that can
be transferred from generation to generation. Please
see the Health Research page for a copy of the Liver
Enzyme Research Form, which is part of the Health
Questionnaire.
When
checking for possible liver disease in my dog, what
blood work should I get and why?
A
Liver Panel, consisting of ALT (alanine aminotransferase),
AST (aspartate aminotransferase), GGT (gamma-glutamyltransferase),
AP (alkaline phosphatase), albumin, and TP (Total
Protein) should be obtained. Remember that
everything that enters the blood stream will pass
thru the liver one or more times, and can influence
test results. These include bacteria, antibiotics,
food, hormones, etc.
ALT
is elevated during infection, inflammation, antibiotic
therapy, and liver pathology, among others. A
laboratory value of greater than 3 times the upper
limit of normal (Reference range of 10-100) [a value
of > 300] would indicate that further study is
necessary to find the cause. It does not mean
there is liver disease, as there is not enough information
based on this one value and one laboratory parameter
alone.
AST
can be elevated because of age, obesity, pathology
involving the liver as well as the biliary tract.
AST is a less reliable indicator of liver
disease, as other organ disease can cause a release
of this enzyme. AST is present in muscle and
other organs, and damage or disease in those extrahepatic
areas can cause elevation. Thus, an
elevated ALT and a ‘normal’ AST may not indicate
liver disease at all. An elevated ALT with
an elevated AST likely is liver disease, especially
if they are >3x the upper limit of normal. Thus,
an ALT of 182 and an AST of 106 are within acceptable
ranges, because they are < 3x the upper limit
of the reference range.
Depending
upon the other liver enzyme levels, and what your veterinarian
believes may be happening in your dog, further lab
work may be indicated following treatment of any
current infection with antibiotic therapy.
-
GGT comes primarily from the liver and can be elevated
with liver disease, gallbladder disease, and
pancreatitis. It can be increased by anticonvulsant
and by glucocorticoid drugs.
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AP is highly sensitive but not very specific for
liver disease in dogs. But an elevation of
GGT increases the specificity of AP(in dogs). (Thus,
an elevation of GGT as well as AP is highly indicative
of liver disease) AP is also elevated during
growth spurts, especially in dogs. It is increased
by the presence of infection, some antibiotics,
anticonvulsants and glucocorticoids, and mildly
elevated in both hypo and hyperthryoidism. Highest
levels are seen in fatty liver disease.
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Albumin may be decreased because of lessened liver
function in hepatitis, or because of ascites. Hypoalbuminemia
(decrease in albumin) is indicative of severe liver
disease, or may be indicative of kidney disease,
with protein losses across the basement membrane
in the glomerulus in the kidney.
-
TP is a rather quick test to determine if there
is a drop in total protein because of liver or kidney
pathology, or if there is a malabsorption of food
from the GI tract.
Rationale
for doing a Liver Panel, rather than just one test:
No
one component of the Liver Panel is diagnostic of
liver disease, or of any other disease. Values
from all components must be taken together to determine
the cause for the elevation, whether or not it is
of concern, and what further clinical evaluations
are necessary. Because infection can
cause an elevated ALT, your veterinarian will look
at urine and other areas, perhaps treat with antibiotics,
then follow up with repeat blood work after the
course of therapy has been completed.
Q.
What kinds of lab work should I get to check
for kidney disease?
A. BUN (blood
urea nitrogen) and Cr (creatinine) definitely should
be checked.
BUN
can be elevated by anything that increases metabolism
or causes an increase in the breakdown of protein
in the blood stream. Fever, infection, glucocorticoids,
and GI bleeding, are but a few of the factors that
can increase BUN. Thus, BUN is not the best
indicator of decreased kidney function. Normal
BUN is ~ 10-20 (mg/dl). (A reference range
of 9-15 is essentially the same as 10-20).
Cr
comes from the muscle, is released at the same rate
every day, and is elevated only in kidney disease.
Consider 1 as a normal Cr and that 1=100%
of function. A Cr of 2 = 50% of kidney
function; a Cr of 10 = 10% of kidney function. These
are not scientifically accurate, as specific function
tests are required to assess kidney function accurately.
However, the reciprocal of the Creatinine
(1 over the Cr value) will give a ballpark value
until specific function tests are done, if they
are done at all.
Q. Should
I do one of those ERD or early renal disease studies
on my dog to be sure?
A. Some veterinarians
like to do ERD on dogs to test for the possibly
of kidney disease, but they also do BUN and Cr at
the same time. There seems to be some controversy
in the veterinary literature as to the specificity
and the sensitivity of this test, and there is no
universal agreement in the veterinary community
as to the validity of nor to the application of
the values in determining kidney function. Meanwhile,
BUN & Cr are universally accepted kidney function
test and the meaning of those values is universally
accepted. Your own veterinarian should be
able to guide you.
Q.
I’ve heard that some people are routinely
doing thyroid tests on their dogs, but why should
I do that?
A. Because some owners have
reported hypothyroidism (sometimes called lazy thyroid
by lay folks) in their AKK, obtaining and providing
the results of a Thyroid Panel can help identify
if this is a problem that is specific to the AKK
breed. Hypothyroidism can be the culprit in
male dogs being unable to produce sufficient quantities
of healthy sperm and female dogs failing to cycle,
infertility, abortion or poor litter survival. Hypothyroid
dogs can also have involvement of several organs,
can seem ‘lazy’ or slow to move, or may actually
have a pituitary tumor.
Q. What
other blood work should I get?
A. At
some point, you will want to have a baseline Chemistry,
including electrolytes, and CBC (Complete Blood
Count) with Diff (differential or breakdown of the
various white cell counts). Establishing a
baseline will help in any kind of assessment should
your dog develop any illness. Having your
dog’s ‘normal’ blood work on file can save time
later in determining if there have been any changes
from your dog’s normal values, and if they may be
due to pathology.
Resources
for this information came from:
Connolly, Patrick
(DVM) Conejo Valley Veterinary Hospital, Thousand
Oaks, CA, personal communication
Cunningham,
James G (DVM, PhD) Ed.,Textbook of Veterinary Physiology,
3rd ed., Chap 31, Postabsorbtive Nutrient Utilization
p308-321 in Sec IV, WB Saunders Co. Philadelphia,
PA, 2002
Hepatic Diseases in Small Animals ,
p 326-332 in The Merck Veterinary Manual, 8th Ed,
Merck & Co, Inc, Whitehouse Junction, NJ, 1998
Meyer,
Denny (DVM,DAVIM, DACVP) Gilead Sciences, Boulder,
CO, & Twendt, David C (DVM, DACVIM) Colorado
State University, “Liver Diseases” in Lecture Notes,
June 2001, The District of Columbia Academy of Veterinary
Medicine
Rose & Black’s Clinical Problems
in Nephrology, Chap 17, Prerenal Disease, p207-219,
Black, Robert M Ed., Little, Brown & Co, New
York, 1996
To
assist you in keeping track of your dog’s lab values,
please see the attached Flow Sheet that can be helpful
in quickly determining any changes.
Stay
tuned to this page, as we bring you more health
related information.
Submitted
by Lo Binkley 07.15.04
Please
forward any comments about this information to the
Health & Medical Research Committee c/o Lo Binkley
at lobink@roadrunner.com.
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