Cold clammy skin, rapid weak pulse 170 bpm, blood pressure 83/68 mm Hg, CRT > 3 sec, bilateral decrease of lung sounds at 2 bases, substantial ascites Severe kidney failure (GFR = 11 mL/min/1.73 m2), intra-abdominal pressure = 28 cmH2O, HCT = 25%, PLT = 25 × 109/L, AST = 1081 U/L, ALT = 336 U/L, Troponin I = 1933 pg/mL. Lactate = 5.1 mmol/L, NH3 = 130 μmol/L. This evidence concerns the gene GPT and kidney failure.