Tuberculosis is a multiorgan disease with varied clinical presentations and is reemerging due to increasing immigration and\r\nglobalization.We present the case of an immigrant female patient who developed acute renal failure with clinical and biochemical\r\nfeatures suggestive of lupus nephritis but with a timely renal biopsy showing caseating granulomata in the renal parenchyma\r\nconsistent with renal tuberculosis. Despite treatment with antituberculosis treatment and resolution of TB on repeat renal biopsy,\r\nshe remained haemodialysis dependent. We discuss the diagnostic challenges faced in this presentation and also explore possible\r\ndifferential diagnoses. This rare presentation highlights the importance of renal biopsy in the diagnosis and treatment of acute\r\nrenal failure and the atypical presentation of tuberculosis.
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