A 50-year-old woman presents to the outpatient clinic with a three-month history of persistent flank pain, unintentional weight loss, night sweats, and fatigue. She also reports haematuria and a notable decrease in appetite. Her medical history is significant for previous pulmonary tuberculosis, which was treated successfully five years ago.

On examination, she is afebrile but appears ill and mildly dehydrated. There is tenderness in the right flank area. Laboratory tests reveal anaemia and elevated erythrocyte sedimentation rate (ESR). Urinalysis shows the presence of red blood cells and white blood cells, along with cultures that grow Mycobacterium tuberculosis. A CT scan of the abdomen reveals renal masses consistent with renal tuberculosis and associated lymphadenopathy.

The patient is diagnosed with renal tuberculosis, likely due to reactivation of her previous infection. She is started on a multi-drug antituberculous regimen, including isoniazid, rifampicin, ethambutol, and pyrazinamide, and referred for further evaluation of her renal function. She is educated about the importance of adherence to the treatment plan and is scheduled for regular follow-ups to monitor her response to therapy and manage any potential side effects.