A 46-year-old housewife with regurgitation of mitral valve developed acute renal failure due to acute thrombosis of bilateral renal arteries after cardiac catheterization. A regional fibrinolytic therapy using transarterial infusion of tissue plasminogen activator (t-PA) was performed at 8 h after the onset, and was successful. She could be taken off hemodialysis 2 weeks after the fibrinolytic therapy, and could be successfully operated on with mitral valve replacement 7 months after that. Three years after mitral valve replacement, her serum creatinine was 148 mumol/l. This is the longest follow-up case after regional transarterial fibrinolysis of acute thrombosis of renal artery using t-PA, and this therapy is a safe and good one for acute thrombosis of renal artery.