While the diagnosis of renal tuberculosis in the presence of tubercle bacilli in an acid urine, frequent and painful urination, pyuria, hematuria, albuminuria and pain in the kidney region is obviously simple, any or all of these symptoms may be lacking and its detection correspondingly difficult. The absence of tubercle bacilli from the urine in the presence of renal involvement is not uncommon in the early stage of the closed parenchymatous type of infection before extension to the pelvis of the kidney has occurred, while later failure to demonstrate the bacillus is more often due to occlusion of a tuberculous ureter. In addition, there are also intervals during which, even though the ureter is patent and the process involves the renal pelvis, the urine contains no tubercle bacilli, just as in pulmonary tuberculosis the sputum is occasionally free from these organisms. Of considerable interest in this connection are Hobbs' 1
STEVENS WE. DIAGNOSIS OF RENAL TUBERCULOSIS. JAMA. 1927;88(2):71–77. doi:10.1001/jama.1927.02680280001001
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