Pulmonary tuberculosis with genitourinary involvement: presentation as “putty kidney”

Abstract

Genitourinary tuberculosis is an extrapulmonary manifestation that is often underdiagnosed
due to nonspecific urinary symptoms. Renal involvement may progress to advanced destruc
tive disease with diffuse calcification (“putty kidney”), leading to severe urologic sequelae,
chronic kidney disease, and even nephrectomy. We report a 28-year-old man with microbio logically confirmed pulmonary tuberculosis (positive smear microscopy, molecular testing, and respiratory culture) who developed worsening urinary symptoms (dysuria, hematuria, urinary frequency, and flank pain) and fever during hospitalization. Urinalysis revealed sterile pyuria, proteinuria, and acidic urine; urine mycobacterial smear and culture were positive. Ultrasound and non-contrast abdominal CT demonstrated advanced right renal involve ment with calcifications and urinary tract stenosis, consistent with advanced genitourinary
tuberculosis. A multidisciplinary approach was implemented, including double-J ureteral
stent placement and continuation of standard anti-tuberculosis therapy. Renal function remained stable throughout hospitalization and follow-up. This case highlights the need to consider genitourinary tuberculosis in patients with persistent urinary symptoms and sterile pyuria, particularly in the setting of active tuberculosis, to prevent irreversible renal damage