Renal tuberculosis is due to hematogenous dissemination of mycobacteria into the genitourinary tract in patients with primary pulmonary infection, reactivation of tuberculosis, or cornual tuberculosis. Mycobacteria from regional lymph nodes enter the bloodstream through the thoracic duct and silently disseminate to the kidneys. Mycobacterium tuberculosis may enter the medullary space, leading to granuloma formation. Fibrosis may occur as the granuloma heals (in the absence of overt nephropathy), or it may rupture into the lumen of the renal tubule many years after the initial infection, thereby releasing Mycobacterium tuberculosis into the urinary tract and leading to continuous dissemination of the infection. Downstream spread of infection to the ureters and bladder can cause ureteral strictures and obstruction, hydronephrosis, and renal impairment. Patients with genitourinary tuberculosis should receive antituberculosis treatment; generally, the approach is the same as for tuberculosis. In patients with ureteral stenosis and hydronephrosis, early placement of a stent or percutaneous nephrostomy is beneficial in cases of potentially reversible obstructive nephropathy. Patients with renal tuberculosis should go to a hospital for standardized treatment to avoid delays.