Protein/albumen/globulin - Oh My!

[Guest BeakerBoy]

Beaker had his annual checkup a month or two ago and, coming out of that, the vet said his albumen was low. She said she was worried about protein loss, so she then ordered a cortisol level to see how that came out. Since that was normal, I wanted to understand more about her concerns, so we looked at Beaker's previous records and it turned out that his last albumen level (a little over a year ago) was even lower than this year's. She said normal levels are 2.6 or higher - his 2012 level was 1.8 and his annual checkup level was 2.1. Since the level was moving up and he's been moved to a new food in the last six months, we decided to do another albumen level. That one just came back today at 2.2, so still trending up, which is good, but she said his globulin (which has never been tested before) is a bit low - it was 1.9 and the normal range is 2 - 4.4, but since I have nothing to compare it to, I don't know if that level is better or worse than what he's had in the past. She said that, since his total protein level is 4.1 and the normal average is 5, this is something I should keep an eye on. She's referred me to a specialist, so I'm going to chat with them to get their thoughts.

 

So here's my question for this group! Does anyone have any experience with this kind of issue? Beaker has zero symptoms - this whole thing only started because of the low albumen level at his annual checkup this year. The vet admitted she missed the even lower level at last year's checkup, so the fact that it's trending up combined with the fact that he has no symptoms makes me feel like this isn't a huge issue. The vet said the danger is that he could be losing protein through his GI tract, which could lead to edema and/or could be indicative of cancer, and that the only way to determine if that's the issue for sure is to biopsy his GI tract, either through endoscopy or exploratory surgery. I really don't want to go down that road unless it's absolutely necessary, so I'll start by discussing this with the specialist, but I wanted to get a gut-check from this group. Any thoughts appreciated!

[macoduck]

http://www.greythealth.com/blood.html Dr Stack's site has good info:

 

NORMAL VALUES FOR:
T.P. Globulin

Greyhound: 4.5 - 6.2 Greyhound: 2.1 - 3.2

Other dog: 5.4 - 7.8 Other dog: 2.8 - 4.2

Greyhound total proteins tend to run on the low end of normal - T.P.s in the 5.0's and 6.0's are the norm. While the albumin fraction of T.P. is the same as other dogs, the globulin component is lower.

Creatinine

Greyhounds: .8 - 1.6

Other dogs: .0 - 1.0

Greyhound creatinines run higher than other breeds as a function of their large lean muscle mass. A study at the Auburn University College of Veterinary Medicine found that 80% of retired greyhounds they sampled had creatinine values up to 1.6 times as high as the top of the standard reference range for "other dogs." As a lone finding, an "elevated creatinine" is not indicative of impending kidney failure. If the BUN and urinalysis are normal, so is the "elevated" creatinine.

[Guest BeakerBoy]

Thanks for the info, macoduck. The fact that greyhound bloodwork tends to run on the lower end of normal makes me feel like the risk of something being wrong with Beaker is even lower, especially when coupled with the fact that his albumin has been trending up (albeit slowly). I'll still keep looking into this though.

[tbhounds]

If you feel further testing is in the future I would run a bile acids test (to check liver function) and a urinalysis looking for proteinuria.

[MaryJane]

As a next step, I would probably check a first morning urine to make sure the specific gravity is OK and that there is no protein leaking through.

[Guest BeakerBoy]

We talked about urinalysis, but my vet said he's likely not losing any protein through his kidneys/urine because of how the other tests came out (the normal cortisol level specifically).

[JJNg]

I agree with the suggestions of a urinalysis, especially before doing anything more invasive like GI biopsies. If there is protein in the urine, follow up with a urine protein:creatinine ratio (UPC). Bile acids is also a fairly easy test to assess liver function, but with no other signs, liver disease bad enough to cause a low albumin level would be very unusual. The normal cortisol level rules out Addison's disease as the cause of low albumin, but that doesn't rule out protein loss through the kidneys due to glomerulonephritis, which is something we can see in greyhounds with no other clinical signs.

[Guest BeakerBoy]

I agree with the suggestions of a urinalysis, especially before doing anything more invasive like GI biopsies. If there is protein in the urine, follow up with a urine protein:creatinine ratio (UPC). Bile acids is also a fairly easy test to assess liver function, but with no other signs, liver disease bad enough to cause a low albumin level would be very unusual. The normal cortisol level rules out Addison's disease as the cause of low albumin, but that doesn't rule out protein loss through the kidneys due to glomerulonephritis, which is something we can see in greyhounds with no other clinical signs.

We talked about bile acids as well, but ruled them out for the same reason you called out - he has no symptoms! Ditto for Addison's - the vet was originally considering that, but ruled it out when the cortisol level came back normal. It's definitely perplexing!