High-dose Tmp-Smx therapy used for the treatment of P. carinii pneumonia in HIV-infected patients leads to an increase in the serum potassium concentration and may result in life-threatening hyperkalemia. Patients receiving high doses of Tmp-Smx require close monitoring of their serum potassium concentration, particularly 7 to 10 days after the start of therapy.

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Deep vein thrombosis is a frequently encountered medical condition, and one that is associated with significant morbidity if not promptly diagnosed and treated.  Anticoagulation alone is, at times, insufficient for recanalization, particularly in those patients with ileofemoral thromboses.  Pharmacomechanical catheter-directed thrombolysis has been used for clot dissolution and removal in these cases.  Although hemolysis could occur due to mechanical lysis of red blood cells during the procedure, acute kidney injury has seldom been reported.  We now report a case of massive hemoglobinuria that occurred immediately after the use of a pharmacomechanical catheter-directed technique to dissolve large deep vein thrombi.  Severe oliguric acute renal failure ensued, complicated by uremic pericarditis and requiring four sessions of hemodialysis therapy.