Acute renal failure after streptokinase therapy in a patient with acute myocardial infarction

Cholesterol embolization syndrome (CES) usually occurs after the performance of invasive vascular procedures. With the frequent use of thrombolytic agents, an increasing number of reported cases of renal CES attributed to the use of such agents has appeared. In most of these reports, the diagnosis was made on the basis of either clinical presentations or skin biopsy. We report a patient who developed acute renal failure as a result of histologically proven renal CES occurring after the use of streptokinase for the treatment of an acute myocardial infarction. The acute renal failure later became chronic; consequently, the patient was placed on continuous ambulatory peritoneal dialysis. Although the prognosis of renal CES has been described to be poor, our patient regained enough of his renal function 8 months after the onset of renal failure to make it possible to discontinue the dialytic therapy.