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What is Steroid-Related Liver Disease?

Steroid therapy may be given to a dog for a variety of conditions, and can be very effective in treating many disorders. Glucocorticoid hepatopathy is a rare disorder which can occur when the liver has scarring and lesions due to a canine’s high sensitivity to steroids. Vacuolar changes in certain dogs’ hepatocytes occur, negatively affecting the liver.

Corticosteroids can adversely affect the liver if the dog is on this type of therapy for a prolonged period of time, if the dosing is not adequate, or if the medication is too strong. When any dog is on steroid therapy, it is very important that the veterinarian looks at every aspect of the dog’s condition and weight to determine proper administration of the medication. Once the dog is taken off the steroids, healing can occur, although it can take months for full recovery.

Steroid-related liver disease in dogs is the result of the dog being overly sensitive to steroid therapy. Steroids can cause lesions to occur on the liver as a result of negative changes in the liver cells, or hepatocytes.

Steroid-Related Liver Disease Average Cost

From 58 quotes ranging from $800 - $3,500

Average Cost

$1,800

Symptoms of Steroid-Related Liver Disease in Dogs

If your dog is on steroid therapy for an illness or disease, it is important to keep a watchful eye for the following symptoms. If any of these clinical signs occur, make an appointment with your veterinarian as soon as possible. Symptoms include:

  • Large amount of weight gain
  • Changes in the skin and coat
  • Increased appetite
  • Excessive thirst
  • Excessive urination
  • Jaundice

Types

Glucocorticoids may be given to canines for a variety of inflammations. Types of inflammations that veterinarians may prescribe steroid therapy for include:

  • Skin allergies
  • Eye inflammations
  • Neurological illnesses
  • Asthma or other respiratory ailments
  • Kidney disorders
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Causes of Steroid-Related Liver Disease in Dogs

The cause of steroid-related disease in dogs is oversensitivity to steroid therapy. This may be related to:

  • Metabolic abnormalities
  • Cushings Disease
  • Congenital abnormality
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Diagnosis of Steroid-Related Liver Disease in Dogs

Once the dog is taken to the veterinarian, he will receive a complete examination, including blood work, urinalysis, and biochemistry profile.  The biochemistry profile will give the medical professional a great deal of information, such as how the liver and kidneys are functioning and a measurement of electrolytes and enzymes within the blood. Discussion of any medications, such as steroid therapy, may take place; however the veterinarian will most likely be aware of the medications the dog is on at this time.

After these primary tests, the veterinarian may perform a radiography of the abdomen to look for any underlying diseases and to take a specific look at the liver. He may also perform an ultrasound to check for specific nodules or lesions on the liver. Histopathology may be performed to look at the tissue of the liver under a microscope to study the disease and its stages. The veterinarian will also examine the size of the liver, lymph nodes, and any cancerous tumors. The medical professional will perform further laboratory testing such as an endocrine panel and a thyroid panel to check for other disorders or to rule out any other abnormalities. 

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Treatment of Steroid-Related Liver Disease in Dogs

Treatment of steroid-related liver disease in dogs depends on the underlying condition. The veterinarian will diagnose the underlying disorder, if any, and relay treatment options to you. If your dog has sensitivity to steroids with no underlying disorder, immediately tapering the dog off the steroids to the point where he is no longer using steroid therapy will usually solve the issue.

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Recovery of Steroid-Related Liver Disease in Dogs

Recovery of any treatment, either invasive or non-invasive, will need to be supported at home. It is important to follow the instructions on after-care provided to you by your veterinarian. 

Recovery of steroid-related liver disease in dogs has an excellent prognosis once the dog is taken off of the steroids. Regular veterinarian visits will need to be scheduled to continue to check the status of the dog’s healing liver. Your veterinarian will communicate with you in terms of what you need to watch for in terms of symptoms.

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Steroid-Related Liver Disease Average Cost

From 58 quotes ranging from $800 - $3,500

Average Cost

$1,800

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Steroid-Related Liver Disease Questions and Advice from Veterinary Professionals

Need pet health advice? Ask a vet

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Ask a Vet

dog-name-icon

Chief

dog-breed-icon

Mix

dog-age-icon

5 Years

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Serious severity

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3 found helpful

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Serious severity

Has Symptoms

Excessive Thirst
Always Hungry
Thin Skin

My dog Chief was diagnosed with an auto immune disease that attacks his joints. As a result he has been on steroids for about 2 years. He is now 5. He has been on Prednisolone 20 mg 1/2 tablet once to twice a day. If he completely is off the steroids he has a very difficult time walking. About 3 weeks ago full blood work was checked and he has a high ALT level and a high GGT. The Doctor prescribed metronidazole and amoxicillin for 3 weeks and even after that it still went up. IV fluids were done for about 2 1/2 days and that did not help. I’m about to start another round of antibiotics and lower his steroids to every 48 hours and I got him the l/d diet. Is there anything else I can do to help him? He is not jaundice and he still acts like nothing is wrong. He is also taking Denamarin.

July 14, 2018

Chief's Owner

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3320 Recommendations

Prednisone is more strenuous on the liver than prednisolone since the liver convert prednisone into prednisolone you’re just removing a step for the liver there The use of Denamarin (silybin and SAMe) is a good supplement to help bring down liver enzymes and the reduction of prednisolone should only be done with guidance from your Veterinarian since we need the immunosuppressive effects of the prednisone; there are other approaches which may be taken (see link below) but you should discuss these with your Veterinarian. Regards Dr Callum Turner DVM http://veterinarymedicine.dvm360.com/recognizing-and-treating-immune-mediated-polyarthritis-dogs?id=&sk;=&date;=&pageID;=6

July 15, 2018

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Bella

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Golden Retriever

dog-age-icon

Eight Years

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Fair severity

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0 found helpful

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Fair severity

Has Symptoms

None

My Bella an 8 yo golden retriever had a senior exam and on her lab results was found to have a slight elevated in GGT. Her AST/ALT were normal. Can prednisone eye drops given 5 times a week for 2 years cause elevation in liver enzymes (like GGT)?

March 7, 2018

Bella's Owner

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3320 Recommendations

Typically an increase in gamma-glutamyltransferase with other parameters being normal may indicate a bile duct obstruction or other bile duct issue; by itself it is not very useful diagnostically. Slight elevations are usually not much to be concerned about, but should be monitored over the medium to long term. Regards Dr Callum Turner DVM

March 7, 2018

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Pearl

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American bully

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2 Years

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Serious severity

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Serious severity

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Our dog Pearl had meningitis when she was 6 months old. One year ago. She got very sick and was put on pain relief medication and prednisone. Max dosage was 40mg every 12 hours. She responded well and within 6 months she was completely weaned of prednisone. She became very very healthy and developed muscle and strength like crazy. Last month she got meningitis again. This time has not responded to prednisone like last time. She is on 50mg every 12 hours. Has lost so much weight and muscle mass. Is still on pain killers and antibiotics. And is low on energy, very down, eats like no ones business and drinks too. She pees in house every night and she's never done that before. She has started shysio and acupuncture which seems to help but has a very enlarged liver. She then just got a staph infection all over her belly and is back on antibiotics for that now. Little and big sores popping up all over her belly and legs. She is still on 55mg prednisone as well as 250mg mycophenolate for her meningitis. 600mg cefaseptin every 12 hours for her staph. 75mg tramadol every 12 hours and 100mg gabapentin every 12 hours. She doesn't seem to be in pain like she was but very very down and no muscle left in her back along her spine and legs. Especially her hind legs. She was super jacked before she got sick this time. She can't even get herself up onto the couch or bed because of her weak legs. We want so badly to drop her prednisone but of course worried about relapse of meningitis. Her belly is very big and round and her spine is swayed.

March 2, 2018

Pearl's Owner

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Dr. Michele K. DVM

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1611 Recommendations

Thank you for your email. I"m sorry that Pearl is having those problems, that is distressing and hard on her, I'm sure. Your veterinarian seems to be doing a very thorough job taking care of her, and it would be best to continue to follow up with them. If they feel that she needs to be on those doses of Prednisone, you may just need to be patient and follow those instructions, as that seemed to be what made a difference for her the last time that this happened. I hope that she continues to recover well.

March 2, 2018

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Lwee

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Belgian Malinois

dog-age-icon

13 Years

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Mild severity

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Mild severity

Has Symptoms

Elevated Alt 417 & Alp 459

My 13 yr old male Malinois was diagnosed with IBD based on GI biopsy(mild LP & eosinophillic enteritis) February 2017. He is being treated with 3 mg Budesonide once a day, restricted diet, vitamin B 12 shots. Other medications he is taking is omeprazole, .5mg Thyrozine, 300mg Gabapentin with salmon oil and an enzyme supplement. His gastric symptoms, discomfort and weight loss has abated. His coat though has gotten very poor and rough feeling. No hair loss or patches. His liver enzymes are elevated ALT 417 and ALP 459 the rest being normal. I have begun giving him Milk thistle. His specialist really doesn't want to lower the 3 mg budesonide. He is in very good condition for his age and is still very active. I would like to know what else can be done to protect his liver. The digestive enzymes and salmon oil has helped his fur but it is still not normal.

Jan. 8, 2018

Lwee's Owner

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Dr. Michele K. DVM

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1611 Recommendations

Thank you for your email. It sounds like you are taking great care of Lwee. Without knowing details of the rest of his labwork and ultrasound results, I can't comment on additional liver protectants, but Milk Thistle is an efffective medication. Vitamin E and Ursodiol are sometimes presribed as well for liver disease, and you can talk to your veterinarian about those medications, and if they would be appropriate with what is going on with Lwee. i hope that everything goes well.

Jan. 8, 2018

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Riley

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Rottweiler

dog-age-icon

5 Years

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Serious severity

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1 found helpful

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Serious severity

Has Symptoms

High Liver Enzyme

I have a rottweiler. He was 90 pounds and began having seizures. I brought him to the vet for the seizures after he had 2 in one night. The vet put him on an aggressive course of phenobarbital in which they kept him overnight. While he was there they reported he had rectal bleeding, swabbed it and discovered he had 0 platelets in his blood. He had NEVER showed signs of bleeding before. They put him on an aggressive course of prednisone and doxycycline. The prednisone was 40 mg, 2x per day. The phenobarbital is 97.2 mg, 2x per day, and the doxycycline was 200mg 2x per day. He was brought back to vet 3 weeks later for a fasting blood check. The pheno levels were good, and the platelets were at near normal levels. I spoke to the vet on the phone about him losing weight and was concerned about the side effects and wanted to know which medication was causing which side effects. They brushed off my concerns, but reduced the dose of prednisone to 40 mg in AM and 20 mg in PM I had to return again 3 weeks later for another check of his platelet levels. This time I asked for an appointment with the vet. At this point our dog had lost a lot more weight and his legs were now giving out from under him. We saw the vet on Wednesday and they did bloodwork. His platelets are at the high end of normal now, but his liver enzymes are incredibly high. Our dog is down to 79 pounds and has lost a lot of muscle mass. We took out night dose of prednisone he is now only on 40 mg in AM. We took him in for seizures, and came out with a very unhealthy dog. His liver values were normal prior to starting prednisone. I asked for copies of blood panels. We are very upset and not sure what to do now. He is now on another medication to protect his liver.

Dec. 16, 2017

Riley's Owner

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Dr. Michele K. DVM

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1611 Recommendations

Regina, thank you for contacting us about Riley - I'm sorry that he is having so many problems. I'm not sure of your question, but will give you my thoughts if they help. It would be very unusual for Phenobarbitol to cause IMHA - there are always the possibilities of drug reactions that we don't expect, but a short term therapy doesn't tend to cause that disease. For his platelets to be that low, I suspect that it was happening and that may have been the cause of the seizure, especially if he had never seizured before? That could be possible if he had some sort of vascular event. The drug dosages that he was put on seem appropriate for suspected IMHA. I'm not sure which liver enzymes were elevated, as there are quite a few that we use to judge liver function, but it is quite common for the Alkaline Phosphatase to increase very dramatically with both Phenobarbitol and Prednisone, so that wouldn't surprise me, and putting him on something like Denamarin is fairly standard to protect his liver from any effects of these other medications - that rise doesn't necessarily mean that he is having liver dysfunction, just that we need to protect it. If other liver enzymes are elevated, that is typically more serious, but again, I'm not sure which enzymes are high, or what levels they are. It seems at this point that you may want to either have a conversation with his veterinarian to see what they think might be going on, as he doesn't seem to be following a normal course of recovery for seizures, although it does sound like both his seizures and his IMHA are under control, and you are weaning him off of his steroids as expected. Both seizures and IMHA can be difficult diseases to treat and manage, and it sounds like there may be more going on with him that caused all this to begin with, as they seem to have been treating his signs appropriately so far. If you aren't comfortable talking with your veterinarian about what is going on with Riley, there is never harm in seeking a second opinion. Sometimes one veterinarian will think of something that another might not, or may have had different experiences. Another option would be to ask your veterinarian for a referral to a specialist, as sometimes we need to use these professionals when animals don't respond the way that we plan them to, and he doesn't seem to be getting better. I hope that Riley gets better and returns to his normal happy self.

Dec. 16, 2017

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Blue

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Golden Retreiver

dog-age-icon

8 Years

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Serious severity

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0 found helpful

pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Serious severity

Has Symptoms

Increase Urination Foamy, Lethargy.

8 yr old golden retriever. sweet sweet boy! our lives happily revolve around him. Latest labs: ALT 127, AST 13, ALP 329, GGT 13, CREA 1.7, CHOL 469, UPC Ratio 3.1, Specific Gravity 1.029, Urine Protein 3+, BUN 42, ALB 2.8, PHOS 3.9. Diagnosis April 2020 was Renal Proteinuria, Stage 2 CKD - after testing to eliminate all other causes of Proteinuria. Plus possible Liver issues. Previously (June 2019) diagnosed w/ Small T Cell GI Lymphoma resulting from chronic GI disease. Meds started to treat lymphoma June 2019: 20mg Prednisone, 4 mg Chlorambucil, 1/8 tsp Tylan Powder, Proviable. B/c of kidney and liver values outside of norm recently, lowered to 10mg Pred past 28 days. Hope to lower to 5mg but concerned that might not be enough support for GI inflammation/cancer. (Plus had Total Hip Replacement after breaking hip playing w/ litter mate at 11 mos old, so weak hind legs and back, so thought Pred might be helping w/ that pain/inflammation too.) Pred certainly helps w/ his appetite, gained 10lbs back after being underweight once Pred started which was a plus. Speaking only as a "Dr. Google-er" but thought High ALT & ALP, high normal GGT and Low AST could be steroid hepatopathy. Vet suggested if Pred is culprit re: liver, would've seen values change sooner (they were normal 6 months after cancer treatment began, started to increase past 2 months). So believes there may be another culprit. My understanding is long-term use of Pred could be a factor even if we didn't see the increased liver values until recently. Ultrasound planned but in past has proven unhelpful diagnostically. Would you suspect to see scars or lesions on liver or something else? Knowit's a delicate dance ahead w/ lowering the Pred, he's also not as hungry which is tough b/c we want him to eat and have quality of life. Recently also transitioning to home-cook diet nutritionist created to address his needs around BOTH the GI cancer and the CKS/Proteinuria. HIs previous diet addressed GI cancer. Wondering if you've had any experience w/ this and any guidance? It would be much appreciated! Thanks in advance!

dog-name-icon

Jexy

dog-breed-icon

Rottweiler

dog-age-icon

13 Years

pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Mild severity

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0 found helpful

pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Mild severity

Has Symptoms

Muscle Atrophy
Loss Of Appetite
Tires Easily

My girl was diagnosed with IMHA in May 2018. She was put on high dose prednisone and we have been slowly weaning her off. She is at 10mg once a day and I hope to get her totally off. This past November she became ill and thought pancreatitis and we found out she had bile duct issue and gallstones. She was prescribed Ursodial and antibiotics and it helped. Unfortunately it was a big setback and now we are getting her to eat consistently. Now her labs values are great except for her live came back super high at 500. The rest of her labs are fine. I added Milk Thistle this week and I hope once she starts eating we can lower her steroid. We are afraid she might have cushings from the steroid use. I guess what I am asking is can the liver improve once we start weaning her off totally off the prednisone.

Steroid-Related Liver Disease Average Cost

From 58 quotes ranging from $800 - $3,500

Average Cost

$1,800

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