Mysterious kidney and liver disease

Hi there, I have a 2.5 year old spayed female dog with no serious prior health issues (mild heart murmur until a year old and then some tachycardia which has since cleared). About 7 weeks ago I noticed she had lost a dignificant amount of weight and had a little trouble urinating a couple of times. Called my local vet who did a urine sample which found struvite crystals and high leukocytes. She was given a 10 day course of amoxicillin and everything seemed normal, urine retested and came back fine. About 5 days after finishing the course she started vomiting and having diarrhoea. Same vet practise weren't particularly bothered and said just to wait it out. After a further 2 weeks of mild diarrhoea, but vomitting stopping after 3 days, she still had diarrhoea but it escalated further into explosive orange liquid. My normal vets were saying they couldn't see her for at least a few days, so I presented as an emergency at a different vet practise. She did a 3-day faecal sample test which all came back negative and they suggested putting her on boiled chicken, which I did for 10 days. During that time she also had a blood test performed which yielded the following abnormalities: Reticulocytes 146.4 (<110), Creatinine 199 (44-133), Urea 11.3 (3.1-10.1), Calcium 2.34 (2.36-2.84), ALT 151.2 (19.8 124.0), Triglycerides 1.39 (0.30-1.20), Bile Acids Random 22.8 (0.1-5.0). As you can see, some of these levels are completely out of range. The new vets who took the bloods told me their hypothesis that my dog must have eaten something extremely toxic in high amounts (lily, foxglove, nightshade etc). My dog is an owner trained assistance dog in training and does not have any time off lead. She is supervised when in the garden, not that there is anything out there that is toxic, there is absolutely no way she could've eaten anything toxic, especially not in large quantities. The new vets have not listened to this and are convinced it is an invested toxin. They've not prescribed any medication or pain relief or any further tests and have said to simply test the bloods again in 2 weeks. I have also started her on the Purina Pro Plan EN gastrointestinal diet, as recommended by the new vet after my dog suffered from constipation for being on just boiled chicken for 10 days. Her stools are relatively back to normal now (a little black and tarry) and no vomitting episodes. She is however bowing a lot in between meals, has a rash all over her body that started on her back legs about 5 days ago, goes through periods of being clingy then taking herself completely away and hiding, she also stares into space and pressing her head on me. I have done some research and feel a lot of her symptoms, even her poor muscle mass and immature/small body structure fits for a liver shunt. The new vets were dubious but said if I really wanted a referral for an ultrasound then they will do the referral as they are not qualified enough to perform it.  I have now found a specialist sonographer who will hopefully be performing an ultrasound next week on her kidneys and liver. I am worried about the results and if nothing is shown on the scan, where do I go from here? What are the medical possibilities for this situation? Before all of this, she was healthy, fed a complete raw diet since 9 weeks old and a new puppy entered the household about 9 weeks ago. Any advice or insight would be much appreciated!

Hello!  I do not know enough about your dogs' condition or the tests to comment on this animal, whom I haven't examined as I am not your vet. Sometimes, for example, a mildly elevated urea and creatinine such as this can come about with dehydration after vomiting a bout and the kidneys still be okay; a diagnosis would have to be made in context, in light of the hydration levels and something called the specific gravity of urine. Again, without knowing more about the urine tests, I cannot comment on these either; how old was the urine, as struvite crystals can sometimes form in urine that has been left for a while. Liver 'enzymes' can also go up and down in healthy animals; they suggest that the liver is working hard, rather than diagnosing liver disease. There are blood tests eg ammonia that can be useful in diagnosing a shunt, but an ultrasound is usually thought to be diagnostic.  You do not explain what the vets are seeing that makes them think this unlikely, but it seems odd that you persist in a referral for a specific test if your vets think it unlikely.  What, in fact, are your vets suggesting? The clinical signs that you list are very wide and varied: Bowing (do you mean the prayer position sometimes seem in dogs with pancreatitis, or a behavioural tic?), Black, tarry faeces (usually associated with digested blood in the gut - please show an example to your vet if so).  I am still a little unsure which organ system worries you. If they don't find what you are looking for on the scans, it may be worth asking your vets what they think the problems are and what they recommend is done from here. If, as you appear to suggest, they don't have a plan, wonder if you have considered asking to be referred to a general medical specialist, who studies the internal body system as a whole (including all the organs) for their assessment?

I should make it clear that black, tarry faeces and the 'prayer position' (bum in air, front end down, to stretch abdomen, and vomiting with no interest in food, are all indications to call the emergency vet to be triaged, if they have not already being checked out.