Nephrogenic ascites

Five of six patients with chronic renal failure and ascites were maintained with intermittent hemodialysis. Other causes for ascites were ruled out in each case by peritoneoscopy, peritoneal fluid studies, and clinical data. The protein content and lactic acid dehydrogenase level of the ascitic fluid in all patients was high, unlike the situation in patients with ascites of uncomplicated cirrhosis. In standard textbooks of nephrology or hepatology, and in reviews of the literature of ascites, little attention is given to chronic renal failure or to peritoneal dialysis being involved etiologically in ascitic fluid accumulation. During the last two years, several patients with chronic renal failure developed persistent exudative ascites, resistant to hemodialysis. Most of the patients had received peritoneal dialysis prior to the development of ascites, but two had not. Ascitic fluid analyses resembled those of exudative peritoneal processes and were quite different from those of Laennec's cirrhosis. The characteristics of the peritoneal fluid, histories, and peritoneoscopic findings for each of the six patients are presented.