We didn't have to ask for a referral to Children's, because she recommended it. The likeliest cause of the problem is posterior urethral valves (PUV), so we will be consulting with the pediatric urologist to confirm the cause and to treat the problem before it becomes a real problem. PUV is the leading cause of renal failure in children. Finding the blockage accidentally may well be the luckiest thing that ever happened in Nolan's life. We may be able to prevent permanent damage to his kidneys and bladder by treating this early.
Many kids with PUV are diagnosed prenatally, but others (with milder valves) aren't found until they are older. Sometimes, the only symptom is failure to thrive. The definitive test is a VCUG, which we can't do with Nolan (already tried that one)! The next step will likely involve a scoping procedure to visualize the blockage, under sedation.
As a side note, Nolan still has his rash and low-grade fever (we're over three weeks with it now), but seems to be acting fine so we're all assuming it is a persistent little virus that doesn't want to go away. He's actually eating a little better than typical, so that is encouraging.
We have our consult with the pediatric urologist on April 30, so we can enjoy our trip to California knowing that our little guy is going to be taken care of!