title: [Massive pulmonary embolism treated with a reduced dose of alteplase in a patient with acute renal failure].
abstract: There are some doubts whether in a severe renal failure the dose of alteplase should not be modified, especially when its plasma clearance may be decreased by liver ischemia. The authors present a case of a 67-year old woman with massive pulmonary embolism (PE) and acute renal failure (creatinine 580 micromol/l) of a mixed etiology (renal calculosis with hydronephrosis and shock as PE presentation). Alteplase administration (10 mg bolus followed by reduced to 50 mg two hours infusion) resulted in hemodynamic stabilization but was complicated by gross subcutaneous hematomas, intensive epistaxis and hematuria, and hemoglobin decrease which required blood transfusions.
authors.affiliation: Oddział Chorób Wewnetrznych, Szpital Miejski ZOZ, Poznań - Nowe Miasto, ul. Szwajcarska 3, 61-285 Poznań, Poland. welikowski@wp.pl
authors.forename: Waldemar
authors.initials: W
authors.lastname: Elikowski
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Małek
authors.forename: Ilona
authors.initials: I
authors.lastname: Bar-Letkiewicz
authors.forename: Stanisław
authors.initials: S
authors.lastname: Kawczyński
authors.forename: Ryszard
authors.initials: R
authors.lastname: Predki
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator