title: Renal failure in ascites secondary to hepatic, renal, and pancreatic disease. Treatment with a LeVeen peritoneovenous shunt.
abstract: Renal failure occurs in ascites of diverse causes. Functional renal failure (the hepatorenal syndrome) in cirrhotic patients is usually progressive and rapidly fatal. Insertion of a LeVeen shunt significantly reduces weight, as well as abdominal girth, and improves preoperative urine flow (488 vs 2,318 ml/24 hr; P less than .001) and natriuresis (12 +/- 15 vs 45 +/- 33 mEq/liter; P less than .003). The shunt should not be inserted in patients with alcoholic hepatitis (bilirubin level greater than 8 mg/100 ml). Ascitic fluid should be discarded at the time of surgery in patients with impaired cardiac function, a bleeding diathesis, and when liver function is more severely deranged.
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000601:surgery; D001201:Ascites / Q000628:therapy*; D006801:Humans; D007601:Jugular Veins / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D009404:Nephrotic Syndrome / Q000150:complications* / Q000601:surgery; D010182:Pancreatic Diseases / Q000150:complications* / Q000601:surgery; D010529:Peritoneal Cavity