My 4 mo old Shiba Inu puppy had a swollen abdomen. At first I thought he had eaten a large meal, but it got bigger so I took him to the ER. He's always been a playful, happy puppy, but drinks a lot of water and eats little. All questions to my vet said that his behavior is normal puppy behavior, and honestly, they had no reason to suspect anything different. To save him pain, we had an x ray done at the vet instead of cyntesis. The xray was obscured by fluid. So we did the cyntesis and a CBC. I have all the results here, so if you need further information, let me know. I don't understand the readout, so bear with me. The thing being tested is listed first, then in the second column is a number. The third column has the units used, I believe? And the fourth is a sliding chart with a high and low number and a marker in between. The BUN has "120+" in the second column and the marker is all the way at the end (25). I assume this just means it was off the chart's scale. The calcium says 10.5 and the marker looks like that's about where it's at. Phosphorous says 9.9+ in the second column, but the marker on the fourth column looks like it's around 5 (the chart there goes from 2.9 to 5.5. Creatinine says 5.4+ and the marker is at the end of the chart (ends at 1.4), again, this just means it's off the scale of the chart I think. GLU says 130+, but the scale is from 60 to 110 and it looks like the marker's at about 100, not the end. Everything else is normal, including protein levels. Could this be caused by his excessive thirst diluting the levels? I know protein will dilute, but creatinine and phosphorous will not. He's still playful as ever. We saw the regular vet today and had an ultrasound (the ER didn't have one), and he didn't see anything that stuck out, though he's not a specialist, admittedly. The playfulness and normalcy of his behavior made both the ER and regular vets say it was probably congenital CRF. The regular vet prescribed Royal Canin LP and an appetite stimulant, as well as aluminum hydroxide to bind to the phosphorous when he eats. He's been eating with less urging than normal, but we've only been back from the vet less than 12 hours and the ER was the night before that. Is this congenital CRF? Is there anything I could have done to cause this? I've had him since he was 8 weeks old and he's been vaccinated and saw the vet regularly (yeast infection in his ears a few weeks ago). He's well cared-for. I feel so guilty about this but the most important thing is that he isn't suffering. When he starts to decline (no longer interested in playing all the time, appears to be in pain), I'll put him down. I have no qualms about that, only with how it got so bad without me noticing. I am literally with him 24 hours a day. He runs, jumps, attacks his toys, digs holes, enjoys his puppy play class and has been working one on one with a reputable trainer since he was 9 weeks old. He's well-behaved, comes when called, can do a couple tricks, etc. My vet is trying to get me into an overbooked specialist here as soon as possible. He spoke to the specialist on the phone and he concurred with the CRF diagnosis. He won't give me a straight answer about the prognosis (understandably, he knows what the dog means to me). I've been in tears, worrying that I did something, let him get into something, should have noticed sooner (he potty-trained like a dream come true, by the way), or there's a solution I'm not seeing. What is your opinion on the situation? Do you think he's in pain? His abdomen is still full of fluid, should it be drained? Would medications that increase kidney function be helpful and extend his life, keeping his quality of life intact? Or is he too far along for them to help and the side effects wouldn't be worth it?