Answer

Case Studies: Glomerulonephritis and Cervical Cancer

Glomerulonephritis

            Blood urea nitrogen (BUN) and serum creatinine levels are important parameters that may indicate whether a given patient is in need of dialysis or not.  BUN levels >100mg/dL may indicate the need for a dialysis (Tzamaloujas, Murata, & Sena, 2019). Creatinine levels ≥5mg/dL would be an indication of severe kidney impairment; hence, the need for dialysis. However, other parameters such as the extent of fluid retention and the potassium level should also be taken into consideration to make informed decisions as to whether a given patient needs dialysis or not (Davis & Shiel Jr., 2019).

            Reduced glomerular filtration rate (GFR) due to glomerulonephritis was the cause hypertension. Fluid intake through drinks and foods did not match the volume of fluid excreted through urine due to reduced glomerular filtration rate. It resulted in increased extracellular fluids including increase in blood volume; thus, causing hypertension (Raj, Garcia, & Gordillo, 2015). Hemodialysis promotes better control of blood pressure and extracellular volume as well as better control of uremic symptoms (Steyaert et al., 2019). Hypertension is a common clinical problem in patient with renal failure; especially, if the GFR is reduced. Strict blood pressure control measures can help reduce the risk of major cardiovascular event associated with hypertension (Jhee et al., 2018).

            A swollen mouth and neck as a result of intravenous pyelogram may have indicated an allergic reaction to the contrast dye that is used in the procedure. A few patients who undergo intravenous pyelogram procedure seem to be sensitive contrast dye or iodine. The allergic reaction manifests with signs and symptoms such as a swollen mouth and neck. To treat these symptoms the patient should have been administered age-appropriate anti-histamine medications (Lojanapiwat et al., 2016). The symptoms may also indicate a possibility of contrast induced nephropathy. Intravenous contrast agents may cause hospital-acquired renal failure; hence, urgent prevention measures should be considered. Contrast agents may cause complications such as stroke, pseudoaneurysms, hematuria formation, pulmonary embolism, and adult respiratory syndrome. Contrast induced nephropathy may be prevented through administration of bicarbonate infusion or normal saline, isosmolar contrast agents, N-Acetyl cysteine, and theophyllines (Thomson, Narayanan, & Singh, 2009).

Cervical Cancer

            Mammography was not necessary following the finding that the lesion on her breast was not cancerous on ultrasonography. The lesion had been diagnosed as non-malignant fibroadenomas. Fibroadenomas is common among adolescent population (Cerrato & Labow, 2013). Mammography is the screening tool for early detection of breast cancer in average-risk women aged 50-74 years. Younger average-risk women of age 40 to 49 years, mammography has be established as an ineffective tool for screening breast cancer (Health Quality Ontario, 2016). The patient was 28-years-old therefore breast mammography was contraindicated. In addition, younger women tend to have increased breast density that may reduce diagnostic accuracy. A high degree of dense breast tissue including the glandular tissue and fibrous tissue may make it increasingly difficult to detect breast cancers on mammography. Increased breast density of breast is directly associated with younger age. In that case, breast mammography is not a perfect test for younger women (Health Quality Ontario, 2016).

            Screening with mammography in the presence of non-malignant fibroedenomas may have resulted in a false-positive result for breast cancer. In high risk-women such as women with dense breasts, breast mammography may give false positive results for breast cancer (Health Quality Ontario, 2016). In a young woman like in this case who was likely to have a dense breast, breast mammography could have resulted in false positive result; leading to over-diagnosis and perhaps unnecessary treatment (Cerrato & Labow, 2013).  Over-diagnosis in cancer screening is defined as detection of cancers or tumors at screening phase that might have not progressed to become life-threatening or symptomatic in absence of screening. Over-diagnosed women may experience side effects and harms of treatment, without any beneficial outcomes (Løberg et al., 2015). About one-third to one-half of breast cancers detected on mammography would not be of any clinical significance (Autier & Boniol, 2018). Mammography was contraindicated in this case, since it could have resulted in over-diagnosis due to dense breasts as well as non-malignant fibroadenomas.

            Sexual promiscuity is related to the risk for cervical cancer. Human papilloma virus (HPV) is the key underlying cause of cervical cancer. HPV also acts a precursor of cervical cancer lesions (Autier & Boniol, 2018). Behavioral risk such as sexual promiscuity, age at first sexual intercourse, and the partner’s sexual behavior tend to increase the risk of HPV infection, HPV infection persistence, and the development of neoplastic precursor lesions (Ribeiro et al., 2015). Sexually transmitted HPV infections result in development of cervical cancer and intraepithelial neoplasia. Women who have many sexual partners as well as those women whose partners tend to have many sexual consorts or have been exposed to HPV previously are in a great risk of developing the disease (Ifemelumma et al., 2019). HPV is largely transmitted via sexual contact. Majority of people with HPV were infected with the virus shortly after indulging is a sexual activity. The peak time for contracting HPV is shortly after one becomes sexually active. Penetrative sex is not necessary for HPV to be spead; but skin-to-skin genital contact is sufficient for HPV transmission (World Health Organization (WHO), 2019).

Certain high-risk HPV strains such as type 16 and 18 can persist in the body despite suppression by the immune system leading to development of precancerous lesions. HPV-16 and HPV-18 causes most of HPV-related cancers (Nardi, Sandhu, & Selix, 2016). The WHO (2019) states that HPV-16 and HPV-18 causes about 70% of all cases of precancerous cervical lesions and cervical cancers. HPV can also cause cancers of the oropharynx, anus, vulva, vagina, and the penis (WHO, 2019). HPV infection is high among women aged 15-25 years. Some women may develop resistance to HPV re-infection following the first exposure. However, sexual promiscuity increases the likelihood of persistent infection with HPV; hence, increased risk of cervical cancer. Persistent HPV infection due to sexual promiscuity tends to predispose one to high-risk genotypes (Ribeiro et al., 2015).