Renal Tuberculosis Presenting as Lateralizing Hematuria Diagnosis by Ureteronephroscopy and Selective Upper Tract Urine Culture

Abstract

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.

Benign lateralizing haematuria: the impact of upper tract endoscopy

“…However, there are a few patients with unilateral supravesical bleeding in whom these initial investigations are normal. While common conditions, including RCC, TCC of the renal pelvis or ureter, and renal or ureteric calculus may still be the cause of bleeding, less common conditions must be considered (Table 1) [1–27]. Second‐line urine, serum and radiological investigations (selective upper tract urine culture, urine microscopy for dysmorphic red cells, haemoglobin electrophoresis, clotting studies, percutaneous renal biopsy, renal angiography and venography, CT or MRI) are therefore often undertaken.…”

Treatment of tuberculous ureteritis. What is the appropriate time for invasive treatment? A case report and review of literature

“…Indications for ureteroscopy are rare but renal tuberculosis should be included in the differential diagnosis of lateralizing hematuria, especially in the absence of an obvious cause for the bleeding. In this case direct culture of urine from the renal pelvis may have more sensitivity than culture of voided urine (8). The confirmation of the diagnosis is based on assessing microscopically the presence Koch' s bacilli in the urine by direct testing for alcohol-acid-resistant bacillus.…”