DMSA Case 5 Answers

1) Suggest the most likely diagnosis.

This is a bit difficult without the plain films but densely calcified kidneys have a limited differential diagnosis. Renal calcification may occur in nephrocalcinosis, which has several causes. Renal hydatid cysts, renal abscesses, and renal artery aneurysms may calcify and mimic renal tuberculosis. However, only the calcification in a failed renal transplant can achieve the calcific density of the scarred, fibrotic non-functioning kidney of the TB "autonephrectomy"

2) Would it surprise you if the patient were asymptomatic?

No. The course of renal tuberculosis may be indolent, with the appearance of few, if any, symptoms. Presentation is usually late and symptoms usually occur as a result as nonspecific urinary tract infection. Constitutional symptoms usually do not occur or are sparse. Renal tuberculosis is usually bilateral although radiologic findings are asymmetric and unilateral in 75% of patients.

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