That's interesting. Thank you all.  In this whole case, the only abnormal finding, so far - on physical exam - is the renomegaly. We are working on our refined list of differentials.   1. How to make the client undertsand to go ahead with this work up (Rads + ultrasound + biopsy) somewhere costs around $800 to $1000 when the client questions that the pet is doing well, why we are doing that?  I apologize for this question but I face a lot of these clients who ask a lot of these questions. My second reason for this question is whenever we send the radiographs and patients for ultrasound, no specialist gives a straight forward answer, the reports are always in possibilities.    2. In our refined list of differentials, do the patients show any changes in the blood work or clinical symptoms, or do they remain asymptomatic until we do the ultrasound and find this out.    Thank you all.   

Thanks Dr. Colleran. Here  is my confusion:   1. Polycystic kidney disease can be asymtomatic as in this case? In this disease should we feel the irregular kidneys?   2. If the client cannot afford the ultrasound, do you think urine Protein Cr ratio will help us as the sediment is quiet in this particular case?   3. Is there any indication for the kidney food at this stage?

Thank you very much Dr. Little for this interesting case.   1. Specific gravity of the urine should not change with time.   2.  We see the VD radiographs and compare the size of kidneys to L2. ( In cats L is 2 to 3 times of L2, Width 3 to 3.5 cm.   3. To confirm the impession of bilateral renomegaly - VD radiograph is required.   4.  1.  Lymphoma      2. Amyloidosis      3. Parasitic      4. Nephritis