The renal failure in the hepatorenal syndrome is unusual because the kidneys are histologically normal and the renal failure may be "functional." Hemodynamic studies indicate that increased renal vascular resistance and decreased renal blood flow may be the primary abnormalities leading to renal failure in some cases. This report describes a patient whose renal failure resolved after placement of a peritoneovenous shunt. A major advantage of this device is that it can be inserted with the patient under local anesthesia with minimal surgical risk. Further studies are needed to define the role of the peritoneovenous shunt in the hepatorenal syndrome.