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Dr. A. Volpi, Servizio di Nefrologia e Dialisi, Ospedale di Vimercate Via C. Battisti 23, I-20059 Vimercate (Italy) Sir, Cardiovascular diseases appear to be the leading cause of death in patients receiving long-term dialysis, and accelerated atherosclerosis is mainly responsible for vascular lesions in uremic patients [1,2]. Moreover hypertension, coronary artery disease, myocardial failure, cardiac calcifications, arrhythmias, and pericarditis are more common in these patients compared to the general population [3]. We have observed a 53-year-old woman admitted in October 1983 because of microhematuria and proteinuria with clinical and renal histological features of Henoch-Schönlein syndrome: her serum creatinine was 1.4 mg/dl. In November 1984 she was readmitted for rapid deterioration of renal function (serum creatinine, 6 mg/dl) and she was treated with pulses of steroid and plasma exchange: serum creatinine returned to 3.17 mg/dl. She developed diabetes and hypertension during steroid treatment. Eighteen months later (March 1985) she was begun on continuous ambulatory peritoneal dialysis for end-stage renal failure. She had experienced angina pec-toris during the previous 6 months and therefore she was treated with calcium channel blockers and nitrates. In April 1986 she presented with prolonged anginal pain and hypotension: ECG tracings showed signs of an acute ischemic lesion of the inferior cardiac wall. Laboratory examinations showed: lactate dehydrogenase 1,031 IU, and creatine kinase 1,366 IU with high levels of MB isoenzyme. She was treated with urokinase by intravenous infusion (a ‘pulse’ of 600,000 U followed by 1,500,000 U in 60 min) with partial regression of the ischemic lesion; afterwards the patient was treated with heparin and nitrates.

Thrombolysis in Myocardial Infarction and Double Aortocoronary Bypass in a Patient on Continuous Ambulatory Peritoneal Dialysis