SummaryA patient developed an occlusion of both renal arteries by extension of a thrombosis of the infra-renal aorta to the superior mesenteric artery. He presented with classical features of acute renal ischemia: lumbar pain, nausea, vomiting, anuria. Since surgery and intra-arterial thrombolytic therapy were not feasible, we performed two peripheral intravenous (IV) perfusions of 50 mg Recombinant Tissue-Type Plasminogen Activator (r-tPA) given at 24 hours interval. During the next month serum creatinine decreased from 8, 8 mg/dl to 2 mg/dl and the creatinine clearance rose from 0 to 20 ml/minute. The patient never required any dialysis. Seven months later his renal function remains stable.