KIDNEY - Hydronephrosis and tuberculosis

A greatly enlarged kidney, together with a segment of ureter which is markedly thickened. The outer surface shows that the kidney is multi-lobed, while the cut surface shows multiloculated cysts, with a very thin rim of cortical tissue at the periphery. At the lower pole, there is a locule containing caseous material. The calyces are greatly dilated and show pale, fibrous bands. The gross appearances are those of tuberculosis and hydronephrosis.
This man was admitted to hospital for nephrectomy for renal tuberculosis. He presented at the age of 31 with dysuria and haematuria, and investigation showed a non-functioning right kidney, and acid-fast bacilli were isolated from urinary cultures. He was treated with anti-tuberculous drugs, but presented again with dysuria and haematuria, and this led to nephrectomy. The histology of the lesion is that of tuberculosis, and tuberculous lesions were found in the ureteric wall as well.