Renal vein thrombosis is a rare entity whose true incidence is unknown. The disease occurs most frequently in patients with the nephrotic syndrome but it also can occur in the presence of other hypercoagulable states. Previous modes of therapy have been limited to systemic anticoagulation or surgery. We report a case of successful dissolution of acute renal vein thrombosis using direct fibrinolytic therapy, which was documented radiographically during treatment and at 3-month followup.