Answer:USMLE step 2 Mcq 129:A 26 year old man complained of a dull ache in her left loin followed a few days later by increased frequency both by day and by night

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Correct Answer: C

Explanation:
renal tuberculosis is associated with pyuria and is commonest in young adults, with a dull ache in one loin, rupture of tuberculous focus into renal pelvis and increased frequency both by day and by night, bleeding not increased by exercise, in male rectal exam reveals thickened lower ureters and nodules in the prostate. The kidney is well vascularized, so hematogenous dissemination to that organ is fairly common. After the typical tuberculous lesions develop within the parenchyma, bacilli are secreted into the calyces, renal pelvis, ureters, and bladder. As a result, tuberculous granulomas, scarring, and obstruction can occur anywhere along the urinary tract. The initial presenting symptoms of urinary involvement are nonspecific. Advanced renal disease and destruction may occur before the diagnosis is made. The urinalysis is often positive for pyuria, hematuria, and albuminuria. Sterile pyuria is classic for renal TB, but many cases with this finding grow cultures positive for other urinary pathogens. The finding of pyuria in an acid urine with no organisms isolated should increase suspicion of TB. Complications of renal TB include nephrolithiasis, recurrent bacterial infections, hypertension, and renal insufficiency


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