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Liver disease in dogs: what ALT, bile acids and albumin show

The liver can be damaged for months or years before a dog looks ill. Chronic hepatitis, the most common long-lasting liver disease in dogs, is often found because a routine blood test shows a high ALT. Here is how vets move from a raised liver enzyme to a diagnosis.

Written by the AI DiagAnimals editorial teamReviewed by the AI DiagAnimals TeamUpdated Our editorial policy

The essentials

ALT is the earliest and best screening marker of chronic hepatitis, and up to 20% of affected dogs have raised enzymes without any signs. Bile acids test liver function. Low albumin, urea, cholesterol or glucose and a high bilirubin appear later, when much of the liver is lost. Some breeds store copper in the liver. The diagnosis needs a liver biopsy; a needle sample is not enough.

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Signs often come late

Early signs are vague and nonspecific. In 294 dogs with chronic hepatitis, the most frequent were reduced appetite (61%), lethargy (56%), jaundice (34%), fluid in the belly (32%), drinking and urinating more (30%), vomiting (24%) and diarrhea (20%) [1]. Overt signs often reflect late-stage disease, and the mean age when signs appear is about 7 years [1].

What the blood work shows

Chronic hepatitis in dogs, ACVIM consensus statement [1].
ValueRaised or low inWhat it means
ALTRaised in about 85%Liver cell damage; the earliest marker, though it can be normal and may fall in end-stage disease [1].
ALPRaised in about 84%Rises later than ALT; also raised by steroids and in young dogs [1, 3].
Bile acidsRaised in about 75%The most sensitive liver function test, but not sensitive enough early on to rule disease out [1].
AlbuminLow in about 49%A late sign that the liver is no longer making enough protein [1].
Urea (BUN) and cholesterolLow in about 40%Mostly in cirrhosis [1].
BilirubinRaised in about halfA sign of a poorer outlook [1].

Clotting times are prolonged in about 40–50% of dogs, and vets check them before a biopsy [1].

How to read the ALT line

Here is an example line from a dog with no signs, found at a routine check-up.

An annotated line from a lab report · Illustrative example
AbbreviationResultUnitLaboratory intervalFlag
ALT Alanine aminotransferase540U/L10–125H
  1. Abbreviation ALT, sometimes ALAT or SGPT.
  2. Result 540 U/L in this illustrative line: more than 4 times the upper limit.
  3. Unit U/L or IU/L, the same number.
  4. Laboratory interval An illustrative dog interval; each laboratory sets its own.
  5. Flag H: above the interval. A persistent rise without another explanation is a reason to look for chronic hepatitis [1]. See high ALT in dogs.

Copper and breeds at risk

Most chronic hepatitis has no identified cause. In some breeds, copper builds up in the liver and damages it: Bedlington Terrier, Dalmatian, Labrador Retriever, Doberman Pinscher and West Highland White Terrier. Cocker Spaniels and English Springer Spaniels also have more chronic hepatitis [1]. Copper is measured on the biopsy sample [1].

Why a biopsy is needed

The diagnosis requires examining liver tissue. Fine-needle aspirates have no role in the definitive diagnosis; the panel advises several biopsies from at least 2 liver lobes, with copper measurement [1]. Ultrasound helps but cannot confirm it.

Outlook

Across 10 studies, dogs lived a mean of about 18 months after diagnosis. A high bilirubin, prolonged clotting times, low albumin, fluid in the belly and scarring (fibrosis) point to a poorer outlook; dogs with cirrhosis may survive only 1 to 2 months [1].

Related articles

En français : l’hépatite du chien.

Questions to ask your veterinarian

  1. How high is the ALT, and has it been raised on more than one test?
  2. Should we measure bile acids?
  3. Are the albumin, urea, cholesterol, glucose and bilirubin normal?
  4. Is a liver biopsy needed, and should copper be measured?
  5. How often should we recheck the liver values?
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Frequently asked questions

What are the first signs of liver disease in dogs?

Often none: up to 20% of dogs with chronic hepatitis have raised liver enzymes without any signs. Later, reduced appetite and lethargy are the most common [1].

Can a dog have liver disease with normal liver enzymes?

Yes. Chronic hepatitis can exist with normal enzymes, and ALT may even fall in end-stage disease [1].

What is ascites in dogs?

Fluid building up in the belly. In liver disease, it often goes with a low albumin and is a sign of advanced disease [1].

Which dog breeds get copper liver disease?

Bedlington Terriers, Dalmatians, Labrador Retrievers, Doberman Pinschers and West Highland White Terriers are predisposed [1].

Can steroids raise liver values?

Yes. In dogs, steroids raise ALP strongly and ALT moderately, without necessarily meaning liver disease [2, 3].

Sources

  1. Webster CRL et al. ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs. J Vet Intern Med. 2019;33(3):1173-1200. doi.org/10.1111/jvim.15467
  2. eClinPath, Cornell University College of Veterinary Medicine. Alanine aminotransferase. eclinpath.com/chemistry/liver/liver-injury/alanine-aminotransferase
  3. eClinPath, Cornell University College of Veterinary Medicine. Alkaline phosphatase. eclinpath.com/chemistry/liver/cholestasis/alkaline-phosphatase

Laboratory methods and reference intervals vary. This article explains; it does not diagnose. For a decision about your pet, use the original report and talk to your veterinarian. Our editorial policy.

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