Renal tuberculosis

Unsuspected renal foci are common in all forms of tuberculosis. 
Early radiographic changes are non-specific but later papillary necrosis, ureteral strictures and particularly calcification are suggestive. 
Sterile pyuria (i.e. white blood cells in the urine but no pathogen found by standard bacterial culture) is the classic finding.
Special mycobacterial culture of 3 morning urine specimens confirms the diagnosis in the majority.


Renal Tuberculosis (Case 1231)

This patient may have presented with dysuria, haematuria or flank pain. Hypertension is uncommon in renal tuberculosis.
Renal failure only supervenes when about 90% of renal parenchyma has been destroyed.

Annotated tb kidney photographThe upper pole calyces and adjacent parenchyma have been largely destroyed, and are replaced by ragged caseous / haemorrhagic material.

The surrounding parenchyma contains occasional pin-head sized tuberculous foci.

The proximal ureter is obstructed by mainly caseous material.
The lower pole of the kidney contains multiple older caseous lesions, exhibiting ("chalky") dystrophic calcification.

This patient was clearly well on the path to autonephrectomy i.e. complete destruction of the kidney by the untreated disease process.