Marked serum <scp>GGT</scp> elevations in two dogs with renal carcinoma

Marked elevation in serum gamma-glutamyl-transferase (GGT) was previously reported in a dog with renal carcinoma (Whitehead et al. 2012). Three case reports of canine renal carcinoma (RC) also mentioned an elevated GGT at diagnosis, but did not discuss the finding as noteworthy (Bennett 2004, Lee et al. 2005, Kye et al. 2011). We report here two cases of canine RC with markedly elevated serum GGT, normal alkaline phosphatase (ALP) and alanine aminotransferase (ALT), and ultrasonographically and grossly normal liver at diagnosis. Both dogs had weight loss of greater than three months’ duration, a large palpable abdominal mass, and were very thin (BCS 2 out of 9). Dog #1 was an 11-year-old, male neutered Labrador-Bernese mountain dog mix. A large right renal mass was confirmed on abdominal ultrasound and CT. The sole abnormal finding on complete preoperative bloodwork was a markedly elevated serum GGT at 245 U/L (normal range: <7 U/L) 12 days before surgery, then 348 U/L five days later, and 226 U/L on the day of surgery. A right nephroureterectomy was performed; the renal mass weighed 1·71 kg. The dog recovered well from surgery but died suddenly a day later despite efforts to resuscitate and necropsy was declined. Histopathology confirmed a well-differentiated tubular RC with lymph node metastasis. Dog #2 was a seven-year-old, male intact German shepherd dog. A large abdominal mass was observed on radiographs, and confirmed by ultrasound examination to affect the left kidney. The only abnormal finding on blood tests was a GGT of 125 U/L. A left nephroureterectomy was performed, during which multiple small nodules were observed on the omentum. The renal mass weighed 2·94 kg. The patient recovered well, and rapidly put on weight. Histopathology confirmed a well-differentiated tubular RC with omental metastases. The GGT decreased to 33 U/L seven days post-operatively, and to 5 U/L on day 14, when adjuvant therapy with toceranib phosphate (Palladia®) was initiated. The GGT increased to 13 U/L on day 30, and was stable at 12 U/L on day 50. Progressive disease was observed by abdominal ultrasound on day 72, and the GGT had increased to 37 U/L. The patient was euthanased on day 87, and a necropsy was not performed. These two cases corroborate that a markedly elevated serum GGT level, with normal ALT and ALP, occasionally occurs with canine RC. Proximal tubular cells produce GGT, but renal GGT generally does not alter serum GGT activity in dogs (Braun et al. 1983). Both dogs had very large, well differentiated but metastatic tubular RC; these variables may play a role in the elevated serum GGT activity that was detected. In people, elevated serum GGT at diagnosis of RC may predict a worse prognosis (Hofbauer et al. 2014). Of five dogs (our two cases plus those reported by Lee et al. 2005, Kye et al. 2011, Whitehead et al. 2012) with RC and markedly elevated GGT (>100 U/L), two died the day following surgery, and the remaining three lived three, six and 11 months. This contrasts with a reported median survival of 16 months in 49 dogs with RC (Bryan et al. 2006). L.-P. de Lorimier1,2 1Department of Oncology,Centre Vétérinaire Rive-SudBrossard, Québec J4Y 1A2, Canada 2Department of Oncology,Centre Vétérinaire LavalLaval, Québec H7T 2P7, Canada S. Bernard Department of Emergency Centre Vétérinaire Daubigny Québec, Québec G1P 2J3, Canada

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