Q: My 61 years old father had falciparum malaria followed by acute renal failure. He was hospitalised for 10 days and one and a half month after discharge, his creatinine level is 1.9 mg/dl. The doctor said that my father is fine and does not need further treatment. However, when we consulted another doctor, he told us that my father’s kidneys might get damaged because of high creatinine level. What should we do?

A:Elevated creatinine level reflects underlying kidney damage/injury, described as acute if it happened over period of few days to weeks as might be in the above case following the episode of malaria, or chronic if it remains elevated for more than 3 months. As part of the work-up to find the cause, one would need to review his urine tests for any signs of protein leakage which is a sign of chronic kidney damage (called chronic kidney disease) and kidney ultrasound to study the size of kidneys. If his serum creatinine was normal prior to malaria illness, then there is a possibility of exposure to a potential kidney toxic medications or severe dehydration impairing the kidney function which takes several weeks to recover. I would recommend close follow-up of his kidney function (namely following serum creatinine level) over next few weeks while avoiding exposure to any potential kidney toxic agents including daily continuos intake of common pain medications like Voveran and Nimulid.