Renal tuberculosis presenting as acute pyelonephritis - A rarity

One of the major health problems faced particularly by the developing world since ages is that of tuberculosis (TB). Genito-urinary tuberculosis (GUTB) is the second most common extrapulmonary TB, with kidney being the most frequent site of infection. Due to the diverse and atypical clinical manifestations of urinary TB, the disease is easy to misdiagnose. The diagnosis of renal TB should be suspected in a nonspecific bacterial cystitis associated with a therapeutic failure or a sterile pyuria and a past history of pulmonary TB with important radiologic findings, particularly with the help of CT scan. Here, we describe a case of renal TB where no clinical or radiological features suggestive of renal TB were present. The diagnosis was only evident after the histopathological examination of the excised kidney. This case highlights the importance of suspecting renal TB as an important cause of kidney disease, which can lead to irreversible renal function loss particularly in an endemic area, and also the diversity that this disease may acquire in its presentation leading to misdiagnosis. In such a case, particularly in a high endemic area for TB, therapeutic trial of ATT may also be considered to avoid unnecessary surgical intervention and end-stage renal disease.