The trip out to VCA Aurora was a busy one. It included an ultrasound and a complete renal evaluation. The following is a summary from the summary we got from the internal medicine service.

Physical Examination: Coat is unkempt in appearance, patchy loss of hair or thinning hair; oral exam presents mild to moderate dental tartar; abdomen is distended and mild discomfort on palpation; cardiovascular presents stage II/VI parasternal heart murmur (this is down from a stage IV/VI heart murmur previously--must've been previously misdiagnosed somehow at VCA Aurora, as our regular vet has always insisted Lars had a stage II vs stage VI)

Diagnostic imaging: abdominal ultrasound revealed small left kidney with moderate renal pelvic dilation (we already knew this from last year's ultrasound--this kidney is basically thought to be non-functional); the right kidney has caudal infarcts which appear to have worsened since the last ultrasound; crystals noted in the urinary bladder (not stones as Dr. E and Dr. L thought); the renal pelvis contains a single stone; pancreas is mildly thickened in comparison to previous studies; mildly hyperechoic liver.

labratory testing: paraphrasing the tech-blood gas analysis came back as being unremarkable; blood glucose came back as hyperglycemic under their parameters at 217. We consider hyperglycemic to start around 250 for Lars ever since his hypoglycemic event back last February, so at 217 we personally consider that to be a pretty good number; kidney values: BUN at 45 and Creat at 2.6--on Saturday they were at 66 and 3.7 respectively, so both of those numbers have come down nicely with the daily 100 ccs of subcutaneous fluids.

Blood pressure: normal at 140/90 This is important because cats in renal failure tend to have high blood pressure.

Pending tests: PTH/Ionized calcium; urine culture and sensitivity; urinalysis

Diagnosis**Open for urinary straining: cystitis vs. urinary tract infection
**Stage II Chronic Kidney Failure
--Renal calculi (stone) with no evidence of obstruction
--Renal infarcts (right)

medication: No medications prescribed or changed today. Continue any previously prescribed medications/treatments as directed.

diet: A renoprotective diet is recommended (ha, good luck with that)

TL;DR: "The ultrasound performed on Lars today shows a single non-obstructive stone within the pelvis of the right kidney. There are suspect crystals in the urinary bladder. There is no sign of urethral obstruction. We are sending urine out for analysis to determine the presence of a urinary tract infection.

"As we discussed, the increased chronic elevation of calcium can cause an increased risk for soft tissue mineralization and stone formation. Once we receive additional blood work we may suggest medication changes."

So after all of that, and A Lot of $$Money, no blockages were found and Lars' kidney values are actually improving again. Figures, right? :o/ Regardless, it was worth the peace of mind to rule out The Worst Case Scenarios. Now we get to wait up to seven business days for the pending results; the ionized calcium test gets sent to a university in Texas if I'm not mistaken, so...yeah...

I think the best part of the day, aside from the most wonderful news of decreasing kidney values and no urethral obstructions, was the vet tech telling us what a good patient Lars was! He was so good, in fact that they didn't need to sedate him for the ultrasound! That's a bit unusual as far as I've heard. I'm still so very proud of my good boy!! :o)

I will definitely keep you all posted on how things progress!! :o) Thanks again for all your support, good thoughts/mojo/prayers/etc.
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