Lysis of Obstructive Renal Pelvic Clots with Retrograde Instillation of Streptokinase

Abstract

In haematuria blood clots may form in the renal pelvis, with risk of outflow obstruction, impairment of renal function, pain and infection. The clots can also provide a matrix for stone formation. Ureteral catheterization and/or pyelostomy may be required if clots are not spontaneously excreted. Based on experience from a case of intrapelvic clotting due to haematuria after renal biopsy, a technique of coagulolysis is described. Via a ureteral catheter a solution of serum and streptokinase was intermittently infused into the renal pelvis. The case is presented. The clots disintegrated within 48 hours and urinary excretion recommenced, with reversal of rise in the blood creatinine level. There were no complications from the procedure, which seems to be a satisfactory alternative to surgical evacuation of clot.