A 60-Year-Old Immigrant from India Comes to the Physician Because

A 60-year-old immigrant from India comes to the physician because of intermittent fevers and weight loss over the last 3 months.  For the past 10 days, he has also experienced a dull ache in the right side of his abdomen.  He considered himself healthy until 3 months ago.  He denies anorexia, vomiting, diarrhea, jaundice, or dysuria.  His past medical history is unremarkable.
His temperature is 37.9 C (100.2 F) , blood pressure is 128/82 mm Hg, and pulse is 84/min.  His BMI is 22 kg/m².  Pulse oximetry shows oxygen saturation of 97% on room air.  His mucous membranes are moist.  Cardiopulmonary examination is normal.  There is no hepatosplenomegaly, but there is some pain to deep palpation in the right flank.
Laboratory results are as follows:

Which of the following is the most likely diagnosis?

A) Nephrolithiasis
B) Perinephric abscess
C) Renal cell cancer
D) Renal schistosomiasis
E) Renal tuberculosis

Correct Answer:

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