The first symptom in tuberculosis of kidney is:
**Core Concept**
The underlying principle being tested is the typical presentation of renal tuberculosis, a form of extrapulmonary tuberculosis that affects the kidneys. Tuberculosis of the kidney, also known as renal TB or genitourinary TB, is caused by **Mycobacterium tuberculosis**. The infection usually starts in the lungs and then spreads to other parts of the body, including the kidneys.
**Why the Correct Answer is Right**
The first symptom in tuberculosis of the kidney is often **hematuria**, which is the presence of blood in the urine. This symptom occurs due to the erosion of the mucosa and the underlying tissue of the urinary tract by the tuberculous lesion. The infection leads to caseous necrosis and the formation of ulcers in the bladder and kidneys, causing bleeding.
**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because while frequency and urgency can occur, they are not typically the first symptoms.
**Option B:** Incorrect because pain is a possible symptom but usually not the initial one.
**Option D:** Incorrect because it is not commonly associated with the initial presentation of renal TB.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that renal TB can be asymptomatic for a long time, and when symptoms do appear, they can be non-specific, making diagnosis challenging.
**Correct Answer:** D. Hematuria.