Dr. Arthi Gauthaman^1*, Dr. Jaganathan Selvanayagam¹, Dr. Rahul S M²

Dr. Arthigauthaman MBBS, MD, Adult Intensive Care Unit, Dr Mehtas Multi-Speciality Hospital, Chennai, Tamil Nadu, India, Email: arthi85med@gmail.com; ORCID ID: 0000-0001-5544-9604

Dr. Jaganathan Selvanayagam MBBS, MD, EDIC, Adult Intensive Care Unit, Dr Mehtas Multi-Speciality Hospital, Chennai 600034, TamilNadu, India, Email: jaganmmc@gmail.com

Dr. Rahul S M MBBS, FCCM, Adult Intensive care unit Dr Mehtas Multi-Speciality Hospitals, Chennai 600034, TamilNadu, India, Email: drrahulsm23@gmail.com; ORCID ID: 0009-0008-5974-2291

Corresponding Author & Copyrights: Dr. Arthigauthaman MBBS, MD, Adult Intensive care unit, Dr Mehtas multi-speciality Hospital, Chennai, Tamil Nadu, India, Email: arthi85med@gmail.com; ORCID ID: 0000-0001-5544-9604.

Citation: Dr. Arthi Gauthaman, Dr. Jaganathan Selvanayagam, Dr. Rahul S M (2026) Spontaneous Renal Recovery After Prolonged Oliguria in an Elderly Septic Patient Managed Without Renal Replacement Therapy: A Case Report. World J Case Rep Clin Imag. 2026 August; 5(2),1-7.

Copyrights © Dr. Arthi Gauthaman, et al., 2026, This article is licensed under the Creative Commons Attribution-Non Commercial-4.0-International-License-(CCBY-NC) (https://worldjournalofcasereports.org/blogpage/copyright-policy). Usage and distribution for commercial purposes require written permission.

Abstract:

Background and Objectives:

Severe acute kidney injury (AKI) in critically ill elderly patients, particularly when associated with sepsis and prolonged oliguria or anuria, is often associated with poor outcomes and may prompt consideration of renal replacement therapy (RRT). However, renal recovery may occur despite profound and prolonged reduction in urine output when the precipitating insult is reversible. We report a case of severe sepsis-associated AKI with marked oliguria and progressive azotemia in an elderly woman who demonstrated substantial spontaneous renal recovery despite initial deferral of RRT.

Methods:

A 78-year-old woman with diabetes mellitus, hypertension, and a previous cerebrovascular accident presented with fever and subsequently developed altered sensorium. She was admitted with severe AKI, oliguria, and evidence of systemic infection. Her clinical course, serial renal function parameters, urine output, microbiological findings, antimicrobial therapy, respiratory status, and outcome were retrospectively reviewed from the hospital records.

Results:

The patient developed fever on 4 July and altered sensorium on 9 July and was admitted on 14 July with severe AKI, with blood urea nitrogen equivalent to a urea level of 131 mg/dL and serum creatinine of 3.75 mg/dL, accompanied by oliguria. Renal function deteriorated further over the subsequent 3 days, with urea exceeding 250 mg/dL, creatinine rising to 7.2 mg/dL, and urine output declining to approximately 100–205 mL/day. RRT was recommended; however, the family initially opted for conservative management. The subsequent clinical course was notable for gradual spontaneous improvement in urine output from approximately day 5, followed by progressive biochemical recovery. By 27 July, serum urea and creatinine had decreased to 96 mg/dL and 1.07 mg/dL, respectively, without RRT. Microbiological evaluation demonstrated Escherichia coli urinary tract infection and multidrug-resistant Acinetobacter pneumonia. Positive 1,3-β-D-glucan and galactomannan biomarkers prompted antifungal therapy. Antimicrobial treatment included meropenem for 7 days, followed by intravenous colistin for multidrug-resistant Acinetobacter, intravenous caspofungin for 10 days, and oral voriconazole for 2 weeks. With control of the infectious process and supportive management, the patient was successfully weaned from non-invasive ventilation and discharged in an improved clinical condition.

Conclusion:

This case highlights that severe sepsis-associated AKI with profound oliguria and marked azotemia does not invariably result in irreversible renal failure or mandate immediate dialysis when there is no absolute emergency indication and close monitoring is feasible. Substantial renal recovery may occur following control of the underlying septic insult and avoidance or minimisation of additional nephrotoxic injury. In elderly critically ill patients, decisions regarding RRT should therefore incorporate the overall clinical trajectory, reversible precipitants, haemodynamic status, electrolyte and acid–base abnormalities, volume status, and individualised goals of care rather than relying solely on the severity or duration of azotemia and oliguria.

Keywords: Acute Kidney Injury; Sepsis-associated Acute Kidney Injury; Oliguria; Renal Recovery; Renal Replacement Therapy; Elderly; Sepsis; Conservative Management; Nephrotoxicity; Critical Care.