Open AccessAlteplase Instillation for Upper Urinary Tract Clot Dissolution
Author(s) -
Alì Mokhtar Mahmoud,
Madeleine Manka,
Roy Lipworth,
Daniel Heslop,
Vidit Sharma,
Douglas A. Husmann,
Mary E. Westerman
Publication year - 2019
Publication title -
journal of endourology case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.123
H-Index - 1
ISSN - 2379-9889
DOI - 10.1089/cren.2018.0088
Subject(s) - medicine , urinary system , upper urinary tract , saline , surgery , urinary tract obstruction , dialysis , creatinine , urokinase , percutaneous nephrolithotomy , tissue plasminogen activator , urology , anesthesia , percutaneous
Background: We report the first case of instillation of alteplase, a tissue plasminogen activator, to dissolve occlusive upper urinary tract blood clot. Case Presentation: A 67-year-old Caucasian man with a solitary kidney became dialysis dependent because of upper urinary tract clot obstruction after ureteral stent placement for obstructing ureterolithiasis. After failure of more conservative measures, 10 mg of alteplase was instilled through nephrostomy tube daily for 2 consecutive days 30 minutes before manual irrigation with physiologic saline. After alteplase instillation, the occlusive blood clot dissolved with rapid improvement in urinary output and creatinine. Conclusions: Alteplase instillation through nephrostomy tube is a viable option to dissolve obstructing upper urinary tract blood clots.