Tuesday, May 12, 2015

Interpreting Lab Results in Context: Cookie's Elevated Kidney Values

It has been my experience that often one value or another can be off on blood panel. With Jasmine, every other panel had something out of range. The question is what to do when that happens? Investigate, figure it out.

It's good to note any values out of normal range but also trends over time.

Values that are off are easy to spot. Then the task is figuring out why they are out of range; what does it mean. Depending on the value and how far out of range it is it might be important or it might be just a fluke. Jasmine would have one value or another out of range every now and then. As long as it was a different one each time and corresponding results were normal, we didn't worry about it too much, though we always investigated and brainstormed to understand why that might have happened.

With Cookie's elevated ALT there were two considerations. Firstly, elevation of that particular liver enzyme needs to be taken seriously, and secondly, it remained elevated from one blood work to another. That's why we pursued further diagnostics.

On Cookie's last blood draw the ALT dropped back down to within normal range.

"The liver enzymes are looking good," the vet said, "we got something new here."

Just to keep me on my toes, I guess, both Cookie's BUN and creatinine were above normal range. "Crap, what now?" I thought to myself, not happy having those two in the red.

BUN and creatinine are values associated with kidney function.

The BUN (blood urea nitrogen) is more ambiguous and can be elevated for a number of reasons. Jasmine's would be slightly elevated every now and then but her creatinine always remained normal. On the next blood draw, her BUN would be back to normal.

Elevated creatinine is much more scary.

But Cookie didn't look like a dog with kidney problems.

There were no signs of a kidney issue and the TCVM exam also didn't show anything of concern. "I'm not feeling what the lab work is saying," the vet said.

However, elevation of these two values is to be taken seriously.

It could have been from dehydration (Cookie's tongue did confirm that she was a bit dehydrated), because she had high protein snack earlier (we were just curious about the ALT so didn't bother to fast her for the blood test). Cookie was also quite stressed this time.

Nothing else on that blood panel was off. We concluded that they kidneys ought to be fine but to be on a safe side, decided to follow up with urinalysis.

Meanwhile, as I came home I pulled out Cookie's previous blood work to look for any gradual increases in her creatinine levels.

Trends can reveal brewing problems before they get into the red.

Particularly with something such as creatinine it's good to look at trends. Even if the values remain within normal range but are gradually increasing, it is something to take seriously.

Cookie's previous results did not reveal any upward trend.

Date Lab Creatinine Normals
8/23/2013 IDEXX 112 29 - 135
3/6/2014 IDEXX 107 44 - 133
10/23/2014 Walden 87 27 - 124
1/14/2015 Walden 97 27 - 124

That was a good sign. I still couldn't help being nervous about what the urinalysis might reveal.

Urinalysis is non-invasive and a great way to assess kidney function.

We collected Cookies first morning urine.

Our trusty urine picker-upper.
Works really great, though not originally intended for that purpose.

For some tests, the fresher urine the better. But for checking kidney function, it is the first morning urine one needs, freshness is secondary to that. I looked nice and golden in the jar, that was a good sign also.

I was very happy to get the call from the vet's office that the urine is normal.

It didn't reveal any kidney problems, or any other problems.

Finally I could truly celebrate the fact that her ALT went down again, and that the kidney blood values were not elevated because of unhappy kidneys. Must have been the dehydration after all.

So that's a load off my shoulders.

I hope the girly gives me a little break in worrying for a while now.

Related articles:
What's in the Urine? (Part II: Urinalysis)
What's in the Blood? Blood Testing and Interpretation

Incontinence? Cookie's Mysterious Leaks
From The End Of A Lead Line To Casa Jasmine: Meet Cookie, Our New Adoptee
And So It Begins Again(?) Our First Health-Related Heart Attack With Cookie 
I Didn't Know I Could Fly: Why Cookie Wears A Harness Instead Of A Collar
C.E.T. Oral Hygiene Chews For Dogs CAN Be A Choking Hazzard 
Our First Health-Related Heart Attack With Cookie: The Knee Or The Foot? 
Creative Solutions And An Incidental Product Review
Too Young For Pot: Cookie's Snack With A Side Of Hydrogen Peroxide  
Taming Of The Wild Beast: Cookie's Transition To Civilization  
Staying On Top Of The Ears: Cookie Is Not Impressed  
Putting The Easy Back Into Walking
Cookie's Ears Are Still Not Happy 
The Threat Of The Bulge Is Always Lurking 
Today Is Cookie's Three-Months Adoptoversary  
Cookie Meets The Electric Horse Fence And Her First Chiropractic Adjustment  
Why Examine Your Dog's Vomit? 
Why Is That Leg Still Not Happy? Cookie's Leg Keeps Getting Sore 
Cookie Too Is Insured With Trupanion
Does Being Insured Mean Being Covered? Our First Claim With Trupanion
Is Cookie's Leg Finally Getting Better?
Is Cookie Going To Be Another Medical Challenge Or Are We Looking To Closely? 
The Project That Is Cookie: Pancreatitis Up Close And Personal  
Pancreatitis: Cookie’s Blood Work   
Another Belly Upset: Pancreatitis Again Or Not?  
Happy Birthday, Cookie 
Who's Training Whom? Stick And Treat 
Don't Just Stand There, Do Something? Cookie's Mysterious Bumps 
Cookie's Mysterious Bumps Update
One Vomit, No Vomit 
Happy One-Year Adoptoversary, Cookie!
Cookie's Leaks Are Back: Garden Variety Incontinence Or Not?
Cookie's Leaks Update 
Don't Panic, Don't Panic: Know What Your Job Is 
The Continuing Saga Of Cookie's Leeks: Trying Chiropractic Approach 
Cookie's Minor Eye Irritation
Regular Wellness Exam: Cookie's ALT Was Elevated 
Cookie's Plantar Paw Pad Injury 
How Far To Take It When The Dog Isn't Sick?
Cookie Has Tapeworm Infection 
Cookie's Elevated ALT: The Ultrasound and Cytology  
Cookie's ALT Update 

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!


  1. It's so scary when levels are off, I'm glad Cookie's turned out okay.

    We've been battling liver levels with Delilah for almost a year, I think we might have a handle on it, but I'm afraid to say it too loudly. :-)

    1. Yeah, I HATE that. Really tired of worrying about one thing or another ...

  2. Glad to hear the tests are headed in the right direction.

    1. Seems like the girls just like keeping my on my toes.