A 32-year-old woman complains of general weakness, low-grade fever persisting for 4 months, lumbar pain, and dysuria. Anamnesis includes frequent acute respiratory diseases, overexposure to cold, low-calorie diet, a case of pulmonary tuberculosis in childhood. Clinical urine analysis: pH- 4.8, leukocyturia, hematuria. Complete blood count: leukocytosis, lymphocytosis, raised ESR. Urography concludes: dilatation of renal pelvis and calyceal system of both kidneys, foci of calcification in the projection of right kidney parenchyma. What is the most likely diagnosis?

Answer options

1. Right renal carcinoma
2. Right renal cyst
3. Chronic pyelonephritis
4. Nephrotuberculosis
5. Acute glomerulonephritis

Explanation

A 32-year-old woman complains of general fatigue, low-grade fever persisting for 4 months, lumbar pain, and dysuria. Anamnesis includes frequent acute respiratory diseases, overexposure to cold, low-calorie diet, a case of pulmonary tuberculosis in childhood. Clinical urine analysis: pH-4,8, leukocyturia, hematuria. Complete blood count: leukocytosis, lymphocytosis, increased ESR. Urography concludes: dilatation of renal pelvis and calyceal system of both kidneys, foci of calcification in the projection of right kidney parenchyma. What is the most likely diagnosis?A. Nephrotuberculosis is characterized by the following symptoms: general fatigue, low-grade fever persisting for 4 months, lumbar pain, and dysuria. In addition, in favor of a specific process, previously a case of pulmonary tuberculosis in childhood. As is known, with tuberculosis, there is often calcification, which can be a source of a specific infection for life. With this, the presence of frequent acute respiratory diseases, overexposure to the cold, low-calorie diet promotes activation of calcification. Availability leukocyturia, lymphocytosis, and increased ESR say more about tuberculosis, which confirms urography concludes dilatation of renal pelvis and calyceal system of both kidneys, foci of calcification in the projection of right kidney parenchyma. B. Renal cyst – this is a urological disease that is characterized by the formation of a cavity formation surrounded by a capsule of connective tissue filled with liquid. The patient may not feel any discomfort or specific signs at all. An extended period of the disease is asymptomatic. For a renal cyst is not typical pulmonary tuberculosis in anamnesis, leukocytosis, leukocyturia, lymphocytosis, and increased ESR. Although it can be observed hematuria. With urography, these changes are not observed. C. Renal carcinoma is a malignant tumor. Most malignant tumors of the kidney are formed in the renal tubules. This type of cancer is called renal cell carcinoma. A malignant kidney tumor can be characterized as a cell mass that divides uncontrollably and has lost the ability to specialize. The faster the cells of such a tumor are divided, the faster they spread to the lymphatic and blood vessels and the more malignant becomes the formation. The clinical picture depends on the stage of the disease and in this patient. But for renal carcinoma is not typical frequent acute respiratory diseases, overexposure to a cold, low-calorie diet, a case of pulmonary tuberculosis in childhood in anamnesis. In addition, the clinical analysis of urine and blood is not characterized by the presence of leukocyturia, lymphocytosis. D. Acute glomerulonephritis is a disease of an infectious and allergic nature with a predominant defeat of the capillaries of both kidneys. It is widespread everywhere. Most often sick at the age of 12-40 years, a little more often men. It is characterized by three main symptoms – edematous, hypertonic, and urinary. In the urine are found protein and red blood cells. But for him, there is no low-calorie diet, a case of pulmonary tuberculosis in childhood in anamnesis, leukocyturia, lymphocytosis. E. Chronic pyelonephritis is a chronic nonspecific bacterial process that occurs predominantly involving the interstitial tissue of the kidneys and the bowel-pelvis complexes. Can be manifested by this symptomatology. But it is not characterized by the presence of a low-calorie diet, a case of pulmonary tuberculosis in childhood in anamnesis, hematuria, and urography data. Based on the history of pulmonary tuberculosis, factors that reduce immunity, the presence of an intoxication syndrome in the clinic against the backdrop of a slowly developing pain syndrome, data on hematuria and leukocyturia with signs of the transferred tuberculosis process, calcification of the kidney parenchyma and expansion of the bowl-pelvic apparatus, diagnosis of nephro tuberculosis.