CASE HISTORY

The patient, a woman aged 44, attended with weight loss, frequency, dysuria and haematuria for 5 months following hysterectomy. There was a history of tuberculous arthritis of the shoulder in childhood. Examination of the urine revealed a sterile pyuria from which TB was never grown. IVP showed an R hydronephrosis with loss of functioning renal tissue and calcification. Streptomycin therapy caused 8th nerve symptoms; INAH and PAS failed to bring clinical improvement, so nephrectomy was performed.

PATHOLOGY

This specimen is a kidney not significantly enlarged although the lower calyces are distended and small tubercles can be seen roughening the pelvic mucosa. The upper pole has been destroyed by pyonephrosis. The ureter, 14cms or which were also removed, showed non-specific inflammation only.