The peritoneovenous shunt in a patient with ascites and renal failure

Summary A diabetic patient with severe diabetic nephropathy and cirrhosis developed medically intractable ascites. A peritoneovenous shunt was inserted and a 4.7-kg diuresis followed, with improvement in ascites, renal function, and ambulatory ability. Prior to shunt placement, Swan-Ganz pulmonary artery catheterization provided useful assessment of cardiac and renal response to acute volume challenge. Primary renal disease is not an absolute contraindication to peritoneovenous shunt placement.