Abnormal Liver and Kidney Labs

Hello! My 14 year old Australian Shepherd mix has developed some elevations in her lab work/UA. Weight - gradual loss of 2-3# over 3-4 years. Excellent appetite. No excessive thirst or urination. Only chronic problem is a recessed vulva that develops external yeast/bacteria infection a few times annually (consulting with derm specialist next month at soonest available appointment. Only other thing to note is she had a spontaneous onset of Horners in May 2022 with resolution. Alk phos: 270 (3/2023), 251 (5/2022), 226 (2/2022), 132 (6/2021), 148 (5/2021) Dbili: 0.1 mg/dL (3/2023) Ibili: 0.2 mg/dL (3/2023) Tbili: 0.3 mg/dL (3/2023) BUN: 37 (3/2023), 30 (5/2022), 27 (2/2022) Urine protein: 2+ (5/2022), 100 mg/dL (2/2022), 30 mg/dL (8/2021 and 6/2021) Pro:Crea ratio: 0.8 (3/2023) I know these values relate to the liver and kidneys. All other chemistry values WNL. Any guidance or suggestions on what to request of vet or conditions to be suspicious of? Thank you in advance! Happy to answer more questions to help form full picture.

Hello!  There is a boundary to be aware of here.   The primary purpose of this site is to supplement, rather than to replace, the role of the vet;  to encourage people to see their vets when appropriate;  to help people make sense of discussion they have had.   In this case, I have been given a moderately good history and lab results to aid a diagnosis, already taken by your vet.  The peice of information missing here, is why your vet hasn't answered this question already.  Is it that they have, and you want to see if I say the same? - in this case it is known as a second opinion and your vet will arrange it for you.  The key thing about second opinions is, that they are usually obtained from someone with more expertise in the area or information than your vet (eg a specialist or someone with access to special tools) and usually done with your vets' permission.   However, useful questions, I can give you....  

What different ways are there of explaining the lab results that are out of range?  These are called the differential diagnoses.  If there is more than one differential, what can be done to tell the remaining possibilities apart?  If not, what are the likely outcomes associated with this problem, over what timescale?  Is there anything that can be done to improve the outcome?  - these are helpful facts to be able to get a hold of.  Sometimes it is useful to ask your vet to write it down, because it can be diffcult to stick it all in your head all in one go.  I cannot diagnose your vets' case - it would be extremely unprofessional, especially because they have more cinical information available to them than I do - but I hope that this is a little bit useful at least.