55 YO recovering from AKI, but the recovery is too slow and fluctuating

Background

My father (55Y, Male) had body pain and fever to begin with. 2 Days later, he was admitted to the hospital due to diarrhea. At midnight, he had no urination, and he was moved to ICU on account of high TLC (~26,000 and continuously increasing) and low platelet (<50,000).

The line of treatment was providing IV fluids to force open the Kidney (or something similar). However, this didn't happen. Fluids spread in the body and also enter the lungs. 12 hours later, the first dialysis was performed, after which his BP and breathing stabilized.

At this stage, Creatinine was around 3-4. As we entered 3rd day of broad-spectrum antibiotics, the TLC kept continuously increasing to 30,000+. Doctors performed Contrast CT as the CT Scans were unclear, and they suspected something in the stomach. Everything came clean. Another dialysis was performed 12 hours after this Contrast CT and Creatinine reached 6. At this stage, urine did start (for a good 24-36 hours or so, there was 0 urine).

From what doctors said: He had multi-organ sepsis, edema in his stomach, and was completely dehydrated.

Dialysis for Fluid Management (Day 2 - Day 6)

Total 4 dialysis were performed for fluid management. The last 3 had o/p of (750ml, 750ml, 500ml) UF. This didn't impact Creatinine or Urea though by a lot though.

Recovery from Spesis (Day 3-6)

Fortunately, he started to recover from the infection. Procalcitonin and TLC level started to drop and over next 1 week, it got to normal. He was donated platelet (SDP); however, it had no impact.

Infection Reports

Blood Culture, Urine Culture, Atypical Infection, Dengue, Malaria, Typhoid reports came negative or sterile. We couldn't conclude what exact infection happened to him.

Post Recovery - AKI (Day 7 - 9)

Platelets also started to recover 10 days later, and urine increased 6-7 days post admission to 50ml per hour and then to 100 ml per hour and peaked around 200 ml per hour. However, Creatinine also kept increasing.

Dialysis for Toxin Management (Day 9 - 11)

10 days after initial admission, due to Creatinine and other KFT/RFT parameter being high, another dialysis was done with 0 ml UF. This brought Creatinine down by 30% to 7.5.

Next day, Creatinine again increased to 9.5 and one good morning at around 3 AM, dad felt a lot of thrust. He drank 1L of water in 1 hour. And that day, Creatinine started to decline.

At this stage, RBC Cells were observed to be 30-40 / HPF -> 50-60 / HPF in 2 subsequent Urine Microscopy.

However, in later reports (After 1 week) they declined.

Recovery of Creatinine and Electrolyte imbalance (Day 12 - 21)

While Creatinine decreased on average of 0.4 units per day (and at days halted at same level), electrolyte like Sodium dropped, Phosphorus kept increasing. Nephrologist started to manage electrolyte. On further test, Sodium was found in urine which confirmed it's dropping in urine.

Urea kept increasing for initial 3-4 days when Creatinine was declining to peak around 164 level.

Creatinine eventually dropped to 6.1 on 21st Day. Urea also declined to 121 on this day.

Reverse in Creatinine Trend (Day 22 - 27)

On Day 22, doctors removed the Foley catheter.

However, last 5 days, this trend has reversed. Today, Creatinine is at 8.2 again and the rate at which Urea was dropping has also declined (93 -> 92) today.

Other reports

  • ANA: Normal
  • C3, C4: Normal
  • KUB USG: Everything was normal in first 3 reports. However, the last report mentioned Both kidneys normal in size and shows raised cortical echogenecity with maintained cortico-medullary differentiation. No calculi or hydronephrosis seen.
  • Urinary Bladder is normal in size.
  • Prostrate is enlarged in size, measuring 37.2 cc in volume with enlarged median lobe projecting 6 mm into bladder.
  • Urine Microscopy is almost normal with RBC: 8-10/HPF. Other parameters were normal.
  • From outside (I think doctors say clinically) he has responded well to treatment. He is walking, talking. A bit tired and sleeping a lot lately and eats very less. He is on renal soft diet and Nephrologists are taking care of diet and medicines being non-nephro-toxin.

Historical Reports

  • My father had annual checkup and all reports were picture perfect (better than mine).
  • His Creatinine was normal ~0.75 in May 2024.
  • He has no previous ailments like Diabetes, BP or any other issue.

Questions

  • Do you have any clue what this could be and why AKI is not resolving?
  • Is there any other parameter I can tell doctor to check for?
  • Any past experience with similar case history? How long does it take to recover from AKI?
  • Are there chances that his kidney will fully recover? What should I be mentally prepared for?