Despite the gradual decrease in the incidence of tuberculosis in the Republic of Belarus, achieved at the present time, the diagnosis of extrapulmonary forms of tuberculosis is still an important issue of Phthisiology. The aim of this study was to identify the features of diagnosis of the case of caseous pneumonia in combination with bilateral cavernous tuberculosis of the kidneys, ureters, bladder. Materials and methods: the map of a stationary patient with an established diagnosis of pulmonary tuberculosis and urinary system was studied and analyzed. The patient was examined out-patient and in-patient with the implementation of all methods of clinical and laboratory-instrumental exami-nation. After verification of the diagnosis of tuberculosis, the patient was given anti-tuberculosis therapy. The results of the study and their discussion. In this paper, an analysis of the clinical case of com-bined pulmonary tuberculosis and urinary system. The given data of clinical, laboratory, radiological and bacteriological examination of the patient with this pathology. The paper draws attention to the difficulties of diagnosis of nephrotuberculosis and its differential diagnosis with nonspecific lesions of the urinary system. The clinical picture of tuberculosis of the urinary system is similar to the symptoms of nonspecific infectious process in the kidneys and urinary tract, which together with the low symptoms of tuberculosis inflammation leads to difficulties in diagnosis. The main importance in the verification of the diagnosis is the detection of reliable signs of tuberculosis – histological de-tection of tuberculosis granuloma and/or detection of the causative agent of tuberculosis in the test material. Conclusion. The clinical picture of tuberculosis of the urinary system is similar to the symptoms of nonspecific infectious process in the kidneys and urinary tract, which together with the low symp-toms of tuberculosis inflammation leads to difficulties in diagnosis. General clinical tests, dynamic renal scintigraphy and multislice CT of the abdomen help to identify nonspecific disorders of func-tion and structure of the kidneys, but reliable data are not tuberculous lesions. To verify the diagno-sis, the detection of reliable signs of tuberculosis – histological detection of tuberculosis granuloma and/or detection of the causative agent of tuberculosis in the test material-is of indisputable im-portance.