Since he has been on such a low protein diet and has urate stones, he needs to see an internist. Ultrasounds are good for some things related to liver and bladder issues, but it is sometimes hard to diagnose a shunt with one. Skipping to a scintography ma be a cheaper option because you may have to have one done even with a "normal" ultrasound.
Five thousand dollars is an extremely high estimate for PSS surgery. There are places that will do it cheaper (UT) if that's the diagnosis. If there is a shunt present (and there may not be), prognosis is probably poor without surgery, esp. with bladder involvement, etc. The surgery does have risks, but in the right hands, there is a very good chance that things will go just fine.
