This case report details a patient treated for a gangrenous toe by angioplasty, sympathectomy, and aortobifemoral grafting who arrived at the hospital with acute renal dysfunction and an occluded bypass graft. The patient had no abnormal results from coagulation studies and no absolute contraindications to urokinase therapy but died from intracranial hemorrhage. The authors believe that hemostatic system impairments related to renal dysfunction act synergistically with thrombolytic agents to produce abnormal bleeding. This case report suggests a synergistic interaction between acute renal dysfunction and urokinase therapy.
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