Abstract A case of a seventy-eight year old woman in whom shock and acute ischemic nephropathy developed following cholecystectomy for acute cholecystitis and cholecystolithiasis is presented. The blood urea nitrogen, which was normal prior to surgery, rose to 54.5 mg. per cent by the third postoperative day. During the final two days of this patient's course respiratory difficulty dominated the clinical picture. This was characterized by an asthmatic type of respiration with subcrepitant and musical rales and expiratory difficulty. Autopsy revealed a fibrinous pneumonitis characteristic of those cases previously described as “uremic pneumonitis.” Concomitantly, a fibrinous pericarditis compatible ith uremic origin had developed.