Eighty-three patients with portal hypertension have been evaluated for the incidence of abdominal inferior vena caval hypertension and the occurrence of a decreased glomerular filtration rate. Portal hypertension was usually accompanied by caval hypertension since both reflect an advanced stage of liver disease. The portal hypertension was always greater than the caval hypertension and some portal decompression will be achieved by a portacaval shunt. The caval hypertension was associated with both abnormal glomerular filtration rate and death from renal failure in these patients with portal hypertension. The caval hypertension, alone, and in combination with other humoral and hemodynamic changes, appears to contribute to abnormal renal function in cirrhosis.