[Ellie May]

With just a high ALT, I wouldn't go to UT too quickly. It is likely LS or MVD, but there is a long list of things that can cause the ALT to rise. Just wouldn't want to see you go all the way there without more proof. Bile acids testing should be done and any vet should be able to understand how to do it when given insructions. All vet hospitals and schools come after UT and Cornell when dealing with LS (IMO). I'd make the trip to UT if one is suspected (after BAT). Although I might also consider scintography around home too just to make sure.

A slightly elevated BUN can be caused by high protein food. The same could be said for ALT, but keeping in mind that the reference range for Idexx is 18-100, this is over 18 times the highest it should be. So, IMO, the protein could not be responsible for such an increase.

I was also thinking about toxicity. There are so many possibilities. If you aren't confident with your vet right now, you could go to your vet school, have them do the bile acids test and whatever else, and then transfer to UT. I'm sure UT would be willing to do testing even if it isn't for LS, but that just seems so far away from you.

Do you have the ultrasound report? What was found? Or did you say vet didn't see the liver at all? Not quite sure why a general DVM was attempting an LS U/S. Even the most skilled with this disease can have trouble with it.

You are right about the K/D. It's low protein, but it isn't the right type. L/D canned is safer.

BTW, Ellie has had three BAT and has been fasted for all of them with no raise in preprandial. I'd do what your vet is comfortable with. Most will still insist on the fast because that's what they have been taught.