I would say you definately are looking at renal insufficieny now, being fasted both the bun & cre should have dropped from the level they are currently under normal fed conditions, so you are likely actually looking at numbers that are a little higher than this last test. (When my CRF cat was recently hospitalized due to food allergy, what little she had eaten the day before & that morning had been vomited back up - esentially like she hadn't eaten- & when they tested her before any meds/fluids were given her numbers were dropping into normal range & when completely normal after several hours on IV fluids) So basically Samantha's "actual" properly-fed numbers will be slightly higher than a fasted test.
With a T4 of 45 I would say she is also either on the verge of HyperT (most likely though) or you caught a high in the number since the values do fluctuate throughout the day. HyperT can also mask the symptoms of CRF and once treatment is started for HyperT the CRF becomes more apparent
As for the blood pressure - many vets won't do it because they feel the test is not acurate enough for a stressed cat with possible health issues including possible low blood flow due to kidney issues, and since it's only one test they have no history to base it on
I've had blood pressure taken on a very stressed badly constipated CRF cat in a "white coat syndrome" conventional vets office (as opposed to her calm homeopath's office) and her blood pressure came back normal @ 120. The BP was repeated a couple of months later during this last hopitalization under similar stressed conditions this time an allergic reaction & it was also normal 120.
Metacam is very likely to be the cause as CRF is a potential risk to develop due to prolonged exposure, diabetes is as well.
The staff @ Canada West is great aren't they
I had to take my
dog there several years ago.