Renal tuberculosis presenting as lateralizing hematuria diagnosis by ureteronephroscopy and selective upper tract urine culture

A 48-year-old man presented with painless left lateralizing macroscopic hematuria. Ureteroscopy revealed flocculent material in the left kidney and white linear streaks on some upper pole papillae; urine culture from the left renal pelvis was positive for tuberculosis, whereas voided urine cultures were negative. Renal tuberculosis should be included in the differential diagnosis of lateralizing hematuria, especially in the absence of an obvious cause for the bleeding. Direct culture of urine from the renal pelvis may have more sensitivity than culture of voided urine in this circumstance.