Renal TB can lead to end-stage renal disease if not diagnosed early and treated correctly. The detection of tuberculosis infection early in life either as primary pulmonary manifestation or as an extra-pulmonary manifestation gives an important clue in a large number of cases and one has to rely on diagnostic approaches like ADA and radiological modalities. The diagnosis in our case was possible because the pleural fluid ADA and radiological injuries were compatible, despite cultures being negative.