Thirteen-year old daschund was presented with the complain of lethargy. Blood test showed renal azotemia, hypercalcemia and high ALKP. A tentative diagnosis of renal failure was masde based on the low USG. On X-Ray, liver was enlarged and US showed a plumpy liver. Urine cortisol to creatinine ratio was done to rule out cushing’s and it was rules out. Addison’s disease was ruled out by doing ACTH stimulation test. Once the dog was placed on fluids, it became perky and started eating and discharged two days later. Another blood test was done after a week and the ALT was 243 and the ALP was 321. I placed her on smaylin and did another blood test after two weeks- which is today. It showed normal ALP but ALT is 307. Initially, when I did the US, the liver architecture looked normal. When I had a look at it again, it looks like there are many pipoint focal hyperchoic areas. Does it indicate neoplasia and the next step should be FNA or trucut biopsy? What do you think about the liver? The dog is clinically doing fine. Happy and eating well now and creatinine is hovering around 3, just a typical CKD dog. There is a persistent hypercalcemia of 12mg/dL