Pregnant Wife with High NMP-22 Protein

[worried father to be]

My wife is 34 yrs old and 5 months pregnant and was sent to the Urologist by her Gynecologist after they found Microscopic Blood in Urine (her original Gyne (no longer an OB) told my wife this situation was also present with our first child's pregnancy 5 years ago (blood in urine).  She sent my wife to a urologist who performed a urine test for infection and to check for NMP-22 Protein and the test was positive two times for the NMP-22 (no infection found).

She has been given two tests, an Ultrasound of her Kidneys and Bladder and a Cystocopy (before the 2nd NMP-22 Test). Both came back negtative.

However, the doctor is still very concerned (actually scarring us to death) because of the elevated NMP-22 test.  He thinks she may have Cancer of the Kidney (since the Cystocopy was negative).

When I research NMP-22 it sounds like its an excellent tool to help track people who had bladder cancer and is exstremely reliable and that is scarring us even more

I guess my question is based on the tests so far both + and - how likely it is that this is Cancer?  What you think of his evaluation and what do you know about the value of NMP-22 for finding new cancers?  Could the pregnancy be causing the elevated levels or could it be normal for her?

What course of action do you suggest for her considering she's 20 months pregnant.

Due to stress on wife and baby your quick response would be greatly appreciated.

Thank You

[Kevin Pho, MD]

None of the urinary biomarkers, including NMP-22, have shown sufficient diagnostic reliability to eliminate the need for cystoscopy for either primary or recurrent bladder tumors. The United States Food and Drug Administration has approved urine tests (eg, BTA Stat, BTA TRAK, NMP22, UroVysion tests) for the detection of recurrent bladder tumors, but none is approved or currently used for widespread screening, initial diagnosis, or risk assessment.

The NMP22 has a relatively poor specificity.  Studies show that the specificity specificity and positive predictive value were 86% and 29%, respectively.  In other words, according to this study, when the NMP22 test is positive when used in the general population, only 29% of those positive have the disease.  

Cystoscopy remains the test of choice to determine bladder cancer.  

I would suggest a second urological opinion if there continues to be concern.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Biblography:
New Urinary Markers for Screening Bladder Cancer
http://www.clevelandclinic.org/urology/news/bladder/vol5f.htm

[worried father to be]

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