Advice re: vet visit

Hello, I'm looking for some advice regarding my recent vet visit for my two cats.

I took both boys in for their annual check up but I'd like more opinions about one of them. He's 4-5yrs old domestic medium hair polydactyl. He was a foster gone adopted because he was too sweet. I've had him for two years now.

He was being fed science diet weight management dry food And friskies wet food crap. I do try my best for these guys but I don't want to feed them just friskies even if it is wet food but I can't afford a premium wet food on my grad school budget. I started getting them Wellness dry food so they'd get more protein. He's never been a good drinker so I put water in the food bowl when he's fed and he drinks that (likes the flavor to it). Both cats had nice soft costs on Science Diet but their coats are even nicer now.

Vet results:
Good weight (5! And 6 for the other not bad!)
Good teeth
Good eyes

I paid for blood work and urinanalysis because I want to get an idea where they're at but I won't be able to get it done every year. I'm studying in America and tuition is a lot here!

His blood work showed high albumin (upper limits of normal) and high calcium (upper limits normal) the vet attributed this to dehydration.

He wouldn't pee in their office so I had to collect at home. This was a struggle and a half due to my schedule and their hours of operation. There are many days I cannot make their office hours so I could only try to get him to pee on wednesday and Thursday mornings. Furthermore I had to get the pee before 30 days were up otherwise I'd have to pay for the analysis.

I got smart, or so I thought.
I SUPER watered down his wet food (basically water with a little flavor) and then when I didn't hear him pee that night I put him in the bathroom at 6am. Went back to bed and 2hrs later the little guy had peed for me, yay!

I took in the pee.. Results... Very Unconcentrated to the point where it looks like kidney failure.

The vet said that given his age and no other indicators he wouldn't put this as kidney failure but instead sees it as dehydration again, fitting with the blood work. I asked if it was possible my tampering led to this but he thought it should have been able to concentrate anyway even though it was rally just water. He wants me to go back to a fiber diet for him. He said that when a cat drinks and pees a lot but it's not concentrated that something is going on. I'm still confused though because I told him this cat doesn't drink much and doesn't pee much. He's beyond loud scratching in the little box so I know when he pees lol.

I understand where he's coming from but I don't like the idea of going back to a carb diet when I have them on this great protein food. If anything id rather see if I could somehow afford protein wet food, but the vet wants the fiber in his diet.

Is this a situation where maybe I could give some pumpkin instead? I'm always trying my best to improve their quality of life because they're my babies and to go back to carbs seems like a step in the wrong direction. At the same time I worry so so much about doing something wrong and them getting sick and often I worry to the point where I feel maybe I don't deserve to have animals and someone else would be able to take care of them better (heaven help me when I have children).

Any tips? =(

/worriedcatmom

Sorry it's taken so long for anyone to respond.  Weekends

Anyway, as I was reading, I was thinking to myself...pumpkin!  Then I saw your question and thought to myself, this poster has been doing some research .

Indeed, pumpkin is a very good source of fiber, and a GOOD fiber at that.  I would certainly try it and see what happens.  PLUS, if you feed Friskies Pates, it isn't such a bad food, carb wise.  Any other Friskies is full of carbs, but the Pate versions aren't too bad.  Fancy Feast Classics and Sheba Pate's are also fairly inexpensive, and a better way to go, if you can swing it.   Plus, Nature's Variety DOG and cat food are (or used to be), the same recipe, so you can actually buy the 13 oz size for much cheaper than the 5.5 oz size.  You could call them and verify which recipes are identical, IF your guys will eat that brand. 

BTW, I've had 3 cats with kidney failure, and this website is my "go to" for that.  Dilute urine is definitely one sign, but if his BUN and Creatinine were in range, that's a good sign.  Here's the website anyway, because it's got so much information and you might be able to use some of it.  It DOES discuss high Albumin:  http://www.felinecrf.org/diagnosis_blood_chemistry.htm#albumin

Yep, I agree. Dilute urine is one sign of kidney disease for sure, but definitely not one that a diagnosis should be based off of solely, especially with it only being dilute one time so far.

Did the blood test include SDMA by any chance? And if so, how was that? That's usually an early indicator (and a fairly new one at that) of kidney disease, even before creatinine and BUN come up high.

I don't think it's anything to worry about just yet. Might not hurt to have it checked again in another three months just for comparison purposes. Perhaps the vet can do a cystocenteisis the next go-around instead of you trying to get it out of him? That doesn't always work either, but it's worth a try. Would not require you to try to get him to drink more to make him pee more!

And like mrsgreenjeens , have had a few kidney kitties myself.

Donutte mentioned the SDMA test. There is also an albumin test, I think by Heska, called the E.R.D. or 'early renal disease". It's a urine test that takes just a few minutes in house and it detects microalbuminuria or small amounts of albumin protein in the urine.

A positive test (i.e. albumin in the urine) indicates that something is “bothering” the kidneys, and you and the vet should start looking to see what might be the cause. Many things, like  dental disease, high blood pressure,, chronic skin infections, and dental issues are a few common conditions that could lead to kidney inflammation and microalbuminuria.  If there is a medical issue, it should be treated, and the E.R.D. test should be repeated four weeks later.  A normal result four weeks later suggests that the kidneys are no longer being irritated, presumably delaying the onset of renal damage in the future.  By detecting kidney damage early and treating underlying causes if possible, we may be able to reduce the long-term impact of kidney disease and give our pet cats extra years of good quality life.

I have seen E.R.D. tests as well as the typical BUN and creatinine tests resolve and go normal after a dental cleaning, or a change in the diet. If you are able, it might be good to run an SDMA and maybe a urinalysis with ERD to get a closer look. Also, that UA should be COMPLETE. That would include microscopic exam for bacteria, as well as casts, crystals, etc. PLUS urine chemistry and specific gravity along with the ERD.

Newer research seems to indicate that it's far more important to reduce PHOSPHATE in the diet, while NOT severely reducing protein. By strictly cutting protein to very low levels, you run the risk of speeding up muscle wasting. In MOST cases of early renal disease, lowering phosphate and ensuring adequate moisture and iron intake is a good way to manage the diet...

Okay, I'm sleepy. I'll add more thoughts after I get some shut-eye.

Thank you so much everyone for the advice, you're wonderful!
Sorry for the delayed reply.. Grad school gets crazy.

I will check out that website this evening and ask about that blood work.

His teeth were perfectly fine according to the vet, unlike his buddy who has a little tartar.
Other than albumin and calcium, all blood work done was normal, but what was done I'm not sure
I'm going to ask for a copy of the results.

When I spoke with the vet about the last results he asked me to get urine again without forcing the water, but because of how this vet is I wasn't sure whether that was hypothetical or real.. Even still I got him a new sample (Tyson is such a good boy.. Helps that I know he always pees aroun 7am!). He tested it and it was still very unconcentraded. I think he's under the impression I switched back the food (couldn't find pumpkin yet), but the only diet modifications I made was refining the schedule/amount.

This time he said he'd like me to come in this week for a urine culture I guess to see if there's an infection? He also said to do a thyroid test though he admitted that the cat is young for that. Then he mentioned the only thing that struck me as possible.. Psychogenic.

Tyson doesn't show any of the telltale signs of an infection from anything I've read.
Tyson doesn't show any of the telltale signs of thyroid problems that I've read.
Tyson has a buddy Benji who isn't always a good buddy and I've thought for a long time may be stressing him out. (I have feliway plugs running for Benji now)
Tyson also travels to my parents home during breaks. I'm going to try to make connections here and get s sitter instead because it may be taking a toll now.
Tyson doesn't show any personality changes but he rediscovered his love for the inside of the couch and I'm working on deterring that again.

Questions:
1) the vet things cats should be fed once, at most twice a day. My cats don't eat enough at one sitting and therefore are little terrors.. Chewing on my binders and schoolwork , tapping me on the shoulder (that one is adorable though), Benji going after Tyson out of frustration. Is it HORRIBLE of me to feed three times a day? I calorie control it, it's all measured and they are smaller meals. The vet makes me feel like I should never ever do this.
2) am I horrible to not spend more money on the culture and thyroid test? Remember this cat had a perfect physical exam.
3) Does anyone have experience with psychogenic food? The vet is recommending it for stress but I read that it's almost a gimmick from the pet food industries...

Please don't think badly of me, these cats are my children and I try my best to take care of them but I need to think of money too. I spend more on their well being than mine, I'm always looking for free meals for myself anywhere I can lol. I just want to try to make the right decisions.

My partner wants me to switch vets, he thinks this one is looking for money. I don't think the vet is, but I also know I easily feel guilty but I won't be able to do all this money wise.. And I don't need the stress about feeling bad. I have enough to focus on with school.

Worst case if it really is stress and I can't remedy it, my sister is madly in love with Tyson and there won't be a Benji there... But I want to make sure that it's very unlikely I'm missing an underlying health problem. =(

I guess the saddest thing about this is that I thought I was doing the right thing by getting baseline work done for the boys but now I'm all conflicted about it because it's just making me feel like I don't deserve them rather than making me feel better.

My partner feels I never should have done it.. Only if something was wrong.

Ugh remind me never to have kids (even thought I want them!). I'm sure this is what parents feel like all the time. Like the world feels they aren't doing enough.

Just makes me want to cry really because I worry for him and I'm not doing good enough.. That maybe if I just stayed at my job instead of going to a grad school in USA he'd have a better life because I could afford everything but instead I chose to be selfish. =(

Sorry I guess I should add that if there was strong evidence to suspect a specific condition of course I'd find the money for that test and follow up. So I guess I'm kinda here for advice and see if there's anything someone says that could push the evidence in a certain direction.

Shouln't my kidney cat, (if he is an early kidney cat) be peeing and drinking more? He's as regular as always and that confuses me. I found it easy to know when to lock him up to pee once I got the hang of it because I realized he's so regular because I feed them at specific times! There's been absolutely no changes at home in him except over the last year he's slowly become even more attached to me and talks/trills more. Nothing I would say is concerning or a swift change in behaviour.

But now I also freak out any time he drinks the water on top of his food and only eats a bit of food... But that could just be that they've now got a taste for regular wet food and are unimpressed with the kibble.

Alright.. I really gotta focus on studying!

OK, here's my unprofessional take on it, since I'm not a Vet.

First off, I feed my cats THREE meals per day, all of them low carb wet food, and I add LOTS and LOTS of  filtered water to those meals.  I make their food kind of soupy since I'm so afraid of getting another kidney cat and I don't want that to happen yet again.  All of my previous kidney cats started out being free fed kibble most of their lives, so I'm hoping this new way of doing things is going to be the ticket to good health for my remaining cats    Of course, as a result of me adding all of this water to their food, it's possible my cals  have dilute urine.  But knowing they get extra water, My Vet and I would not worry so much if that were the case.  BUT, they have never had a Urine Specific Gravity Test done as part of their baseline. Only bloodwork.  

Second, I think getting baseline bloodwork is a good idea, because then of anything happens later on, you have something to compare it do.  Yes, it's causing you worry now, but it's still always a good idea to have it.

Third, cats with early stage kidney disease don't normally show any signs of it.  They don't usually show signs until their kidneys have shut down nearly 75%.  Here's another section of the website I referenced above, only this page is about Early Detection, just in case:  http://www.felinecrf.org/early_detection.htm

Four, since you only took him in because it was time for his annual exam, NOT because he was acting strange, or drinking more and urinating more or anything slightly unusual, and his kidney values were within normal ranges, as were all BLOOD  values, actually, and you cannot really afford more tests right now, I would probably just keep a very close eye on him to see if there is ANY CHANGE AT ALL in his behavior/habits and if there are, THEN I would proceed with some tests.  Not sure it's worth it to check further for kidney disease yet, because, really, not much you can do for that other than diet changes (but see that page I referred.   you to)  I wold say it kind of depends on what kind of changes you see.  Drinking a lot could be signs of kidney OR diabetes, and it could be either with the dilute urine.  OR it could be his thyroid for the same reason, but he might start acting completely different...yowling, acting very hungry, losing or gaining weight...who knows with the thyroid.

Fifth, I've just never heard of Stress causing Dilute Urine before.  Of course, anything is possible.  Stress can cause all kinds of things, that's for sure.  Here are some stress busters to try, if you haven't already:  http://www.thecatsite.com/a/six-surefire-strategies-to-reduce-stress-in-cats

That's just my two cents.  Hope it makes sense. I'm coming down off a migraine and the drugs aren't thru my system yet

Thank you so very much for your reply. I've continued to read through that website (much to the dismay of the neurological HUMAN readings I should be doing =P) and it both relieves me and confuses me since everything was normal (so I was told) except the USG (and abumin upper limits and calcium upper limits). 

This vet is brand new to me. As much as I appreciate his input, we don't have a rapport yet and I'm finding more and more that he wants to run all sorts of different things without providing me with enough evidence to justify them. I also feel like he doesn't listen when I tell him how my cats are behaviourally at home (I tried to stress how much Benji's behaviour concerns me for example). But I hate thinking I may be neglecting Ty's health. I cry when I look at him most of the time right now, because I worry.

Thank you so much about the feeding schedule. Like I said, I was made to feel like the worst cat mom for feeding 3 times a day.

Much like you it's all watered down. At each meal I put 1/3 cup water in each dish first and they drink through that to get to the food.

I feel 3 feedings is helping to reduce Benji's behaviour and therefore help Tyson as well.

My action list right now:

- Get a copy of the expensive test results I paid for, take it to my parents' during the break and pay my vet back home to sit down and TALK about it with me. That will probably be more for me than Tyson, but at least I'll get a second opinion and hopefully be told to calm the heck down! =P

- See what tests were done and if my vet recommends any other tests (like those you guys mentioned).

- Start adding some bach flower formula to water at meal times, at least during the night time wet food meal that they gobble up.

- I've been keeping a diary so I have evidence to support when I tell the vet I KNOW when he goes to the bathroom. Yes I'm not constantly home, but I'm home most of the time.

- More play time with them. Benji and I used to hide and seek all the time, that kinda died off over the last couple busy years and may be upsetting him.

- Watch him like a hawk.. like I have been.

Obviously I am concerned and obviously there is a problem... if the urine is so dilute then I can believe the kidneys are not filtering out all the toxins they should (though supposedly BUN/Creatinine were normal) and that kind of build up in the blood isn't good. It's just about feasibly finding the most likely suspect to get that back on track...

I hope your migraine is relieved soon. =(

Edit: About the symptoms... I was more trying to find if any symptoms of thyroid/diabetes/liver?/UTI matched for Tyson because that would direct me towards one of these many recommended tests... but there hasn't been anything. If my cat had a UTI he really would show -something-, right?

The only other thing I'd say re: psychogenic is recently my partner did move out of the apartment. He's been largely unemployed since we got Tyson and was always home with them while I was at work. I'm not sure how much play time happened during the day since he was on the computer a lot, but I'm sure they're missing his presence at home.


He models my crochet creations. =)

I'm apt to agree with your partner on getting a new vet. The fact that the vet made you feel so bad for the feeding schedule alone gives me enough reason to think that. The fact that he's worrying you so much after one test result. It's not like it was off the charts.

I feed canned twice a day for the "community feedings". Maple gets a third feeding so I can give her Miralax, and Sara is my sickie-poo who is kinda on her own weird schedule (which is whenever mom puts food in her mouth). I also free feed dry; we always have. And I've never, ever had a vet say I'm feeding too often or not enough. Any vet worth their degree should know that not all cats are created equal. Sure, some cats can eat everyone in one sitting. I think the bulk need two or more feedings a day though. Most folks feed three times, from what I've read.

Yeah, that once a day feeding thing is kind of off to me, too. Cats like people do much better when their blood sugar stays at a fairly constant state. That's achieved by serving several small meals-- say, 3 meals a day-- rather than piling it all in at once, encouraging gobbling and the resulting peak, followed by a long trough.

This is especially true when feeding overweight cats or diabetics, seniors or kittens/growing cats, or those who prefer to just pick and graze throughout the day. Have I missed anyone? 

I tried that link and it timed out on me... twice. Tried it without the suffix and it still timed out. But the upshot is that there are tests that can detect early kidney disease before the "traditional" blood tests can, and before the symptoms begin. Early detection is very important, as early renal disease can be slowed down and the cat can have a much better time for a lot longer before the process goes too far. The SDMA and the Heska ERD are two helpful tests to catch very early changes and begin a program to support the kidneys well before kidney "disease" really hits hard.

Even when values do start to creep up a little, if there is dental trouble and periodontal disease, having the teeth addressed and any oral infection brought under control can actually reverse those numbers. I have seen it happen in many patients. But this is for cats in very early stages, and applies if the cat is otherwise okay to have anesthesia-- if the vet thinks the teeth need attention. It's not a bad idea anyway because so many cats and d*gs do have periodontal problems beginning by the age of 3, and by age 5 those things can be quite advanced. This is one reason why regular home and professional dental care is just as important for cats as it is for us. They can't tell us that there's a problem. By the time we notice odd eating or chewing behavior, the mouth is already quite painful. I'm going through this with one of my crew. Happily his kidney values are also perfect and he's not showing any issues there.

I know your kiddo's blood looked fine-- this is something to just keep in mind for when you can swing it. And yes, cystocentesis with ultrasound guidance is the BEST way to get a sample, but it can certainly be done without the sono. I've collected lots of urine that way with no imagery. If the bladder is nice and full, it's easy and pretty painless for the cat. It's just weird to him do be on his back or side with people palpating his lower abdomen. It looks scary to the client to see it taking place if the vet does the cysto in the room, but really it's not so bad at all and it's much easier on everyone, including the cat, to get a "sterile", uncontaminated sample. If the vet needs more urine later, that's really the way to go. He might have to hang out for a while if his bladder's empty, but it takes just seconds to do once he's got something in there. But hey, they hang out while we wait to get a free catch anyway, so it may even be quicker to just get it by cysto.

Odds are, your kiddo is okay. Yes, they can have little low-grade infections that don't cause a lot of serious discomfort, but cats don't always let us know very well when something's just a little off or a little sore. That's why we have diagnostics and regular screenings for things, and we recommend routine blood work to keep tabs on their innards.

But dental care is one important link to kidney health, believe it or not-- issues in the mouth don't stay there!

I really appreciate all your responses. You guys have made me go from feeling like I'm the worst ever for thinking something different from the vet, to feeling like I am indeed doing ok!

I'll go in tomorrow morning to ask for vet records and let them know I'm going over my options, but that I won't be jumping on anything just yet. Then I need to literally calm down and work or my straight A streak is going to be broken. ='(

In terms of dental, like I said, the vet said during the exam that his teeth were great and even used him as an example for good teeth (because my 7 year old had a little tartar on the one side) so I'm hoping that's true and it's all good. Tyson won't let me brush just yet, but we're working towards it while Benji and I aim to brush each day (but I'll admit some days I drop the ball). The vet was funny about that one too. He said there was tartar, so I said "yea I need to get back on a consistent brushing schedule sorry" and he said "No, cats hate brushing it damages the relationship with the owner, the cat will resent you". I explained that Benji is fine with it and I've done it since he was little but still he was saying that it ruins things. So then I was left with the question... what do I do? You told me there's tartar but don't want me to do anything? It was so confusing lol.

I love all the websites and I'll keep using them for reference.

You guys are awesome. =) Good night.

You do whatever home dental care you are able to do with your guys. Period. If all you can do is put some pet toothpaste in his mouth and let enzymes do the work for now, that's what you do. It's a start. You know now how important healthy teeth, gums and mouth are-- you obviously appreciate the importance of that. You get an A for being an aware "Cat Dad" (Cat Mom?). If your guys let you work up to actually brushing-- great! If all you can do is a dental diet and tooth "wiping" that's a lot better than nothing. It does help. That's what we do for infants who are too young to brush. We wipe the mouth and gums, and with cats we consider it a major victory to wiggle a toothbrush around the visible teeth for half a minute or even a few seconds. But IT COUNTS, and it helps. And yes, tartar forms even though your brush every day. It begins as biofilm, a mixture of bacteria and mouth debris that begins to form immediately after a thorough pro cleaning, brushing, flossing and everything else. There are always bacteria in the mouth. There is always biofilm in the mouth, and it becomes plaque (soft, can be brushed and flossed-- in people, not cats!). We brush t remove plaque. Over time, plaque mineralizes into tartar. Tartar can linger against the gums and oral tissues and cause inflammation and even infection. As perio disease develops and progresses, tartar can form below the gumline and cause infection and pain. It's THIS kind of tartar that your own dentist is usually removing, from those places that the brush and floss can't reach.

Break the bond-- tooth brushing? Resentment? No! That's not true at all if you just work really slowly and let your fellas get used to each step before advancing to the next. I too have brushed Schrodie's teeth since he was a 1-3 month old kitter with baby teeth! I got to see him shed his baby teeth, laughed at his funny looking kitten smile as he shed his fangs and had "double tips" for a while as the new fang pushed out the old baby fang. And I saw the development of gingivitis on his incisors. But we addressed it, it cleared up... but I bet it went to the back and became stomatitis. He still lets me carefully open his mouth and look a little or give his pills. That's another benefit of early dental training-- they get used to having the mouth opened and things placed inside (like bush and paste!) If anything, it has enhanced the bond because he is used to the handling and TRUSTS me to not intentionally hurt him that way. Increased trust is a good thing, no?

It sounds like you need to "interview" a new vet and find one who you can work with and doesn't discourage you from these healthy actions.

I went right into brushing with my three youngin's, but I've totally slacked on that since Sara got sick. It's like I just don't have the energy to chase them down these days. I was brushing them every other day for awhile though. This thread reminds me that I need to get back on the ball with that.

OK, again, IMHO, definitely time to find a different Vet.  First the advise on feeding, then the advise on NOT to brush their teeth??????  Does this person even have a degree?  

OK, I'm done ranting now.  (I don't suppose whatever University you're studying at has a School of Veterinary Medicine, do they?   If so, they are great resources!)

Oh, and BTW, my sweet Callie, who was 16 and had kidney disease, never, ever needed a dental in her entire life .  AND, I never, ever brushed her teeth.  Thank goodness she had good genes in the tooth department.   Sven, on the other hand, who also had kidney disease, needed 4 teeth pulled by the time he was seven (when we adopted him) and needed dentals regularly.  So...it really just depends on the cat.

Tyson is SO handsome .  I'm a little partial to black cats.  My two remaining guys are both black

Any other vet visits are going to be to the one I initially researched when I moved here near my campus with excellent reviews. I went to this one instead because I discovered it was in my small town and I like to support small towns when possible... but it's not working out. I do believe he has his best intentions for my pets, but I find communication very troubling with him and he doesn't appear to have that "emotional intelligence" that I may need to calm me down. =)

I picked up their lab results today. No reason to discuss Benji, but it was nice to have two cats to compare results! I also much prefer looking at data rather than numbers being fired at me over the phone.

SDMA was  indeed completed

Tyson - 7 Benji - 11

Only norm listed is an upper limit of 14

Bloodwork Tyson

Albumin - 4.0 (Norm: 2.6-3.9)

Calcium - 11.2 (Norm: 8.2-11.2)

Everything else like blood counts and such, all good.

Urinalysis Tyson

Initial:

- USG 1.009 (I was told this over the phone)

- Mucus present?

- Trace blood amounts?

Second (Only USG was done):

- USG 1.014

So I see that -perhaps- my tampering did bring it down a bit, but yes it's still very dilute. The one thing that I really wish he had mentioned is those other things about the initial urinalysis. I mean at the time perhaps trace blood amounts didn't concern him, but after the second dilute urine... would that not point in the direction of a potential infection? Shouldn't he have mentioned this to me? I'm rather upset he didn't.

What do you guys think? Blood in urine, trace or not... wouldn't that speak to infection? Or is it normal to have trace blood sometimes in the urine (I'd personally think not...).

When I google this I don't get a similar situation to mine because the accounts are of owners who noticed bloody urine. Tyson's urine that I've collected has just been pale (dilute) in colour and I didn't see anything that led me to think blood (but that doesn't mean it isn't there). Could the test have been wrong in detecting blood? Is that possible?

I may have got the evidence I need to proceed (at another vet) with a culture for UTIs.

Great tip about the university and veterinary school... I'll look into it! Thank you!

Thank you for the compliments as well, he's a very "pretty" boy. I call Benji the cute but obnoxious one. I guess that's what happens when a kitten lives in your arms until he's 1.5yrs old lol... and I call Tyson the pretty one because he has such lush fur (being medium hair) and a gorgeous tail. Just hard to get good pictures of him!

Well, I guess since the SDMA was done and is within normal range , seems like you can probably rule out kidney disease. 

Gosh, I wonder if he just naturally has dilute urine?  His IS, technically, within normal range, although they say it should be higher, which I just don't understand.  (why say it should be higher if it's in normal range?)

As to a TRACE of blood in the urine, since YOU collected the sample, it does seem like it is hard to explain.  I don't have even a guess on that, really.  Was there a trace on the 2nd sample?  You didn't list it, so I'm thinking maybe not?   Anyway, I'm wondering if you could simply call the Vet and say you noticed it when you got copies of the reports, and now you wonder exactly what that means?  (other than the obvious)

The second urinanalysis was only USG. It was done at no cost. I'll give a call to ask about it. Thank you. =)