Wow, OK...where do we start with this one? 39 years old, early kidney failure, high LFTs? A fatty diet could potentially explain the high LFTs, but kidney failure in a 39-year-old? Something serious could be going on here! Maybe even...hepatorenal syndrome in the worst case! Perhaps this midlevel should refer the patient to a real physician who can figure out what's going on and help the patient instead of worrying about their own billing and reimbursement.