Q: My 53 years old father is suffering from acute renal failure because of a problem in his liver. He is having jaundice for the last month and later falciparium malaria was detected when he was hospitalised last month. His bilirubin level fluctuates between 30-50 mg/dl; presently it is 33 mg/dl which was 45 mg/dl last month. His TLC counts have also reduced from 28000/ml to 12000/ml and creatinine level fluctuates between 3 and 8 mg/dl and blood urea fluctuates between 120 and 200 mg/dl He is on dialysis every alternate day for the past 2 weeks, and his urine output is 1400-1800 ml per day. He does not have any past history of blood pressure, diabetes or any other disease. The doctor told us that if his bilirubin comes down, the kidney function would improve automatically. How long will it take for him to be all right? How can bilirubin levels be controlled? Is it true that when bilirubin falls, creatinine and urea levels automatically fall, and kidney function improves? For how long does he need dialysis support? He was given Falcigo injection for malaria and Lactihep for loose motions. Please advise.

A:Acute kidney failure in the setting of malaria is usually a consequence of massive tissue break down products overwhelming the kidney filters and clogging them up. Bilirubin is sort of a surrogate marker of tissue breakdown products and can indirectly be correlated with toxin burden the kidneys are exposed to. Usually, it carries somewhat favourable prognosis if kidney function prior to this acute episode was normal. As body recovers and malaria is cured, the kidneys slowly resume the function. Again, part of this depends what was the kidney function prior to this episode, age and severity of malaria.