Clinical Relevance of Serum Amyloid a Protein Monitoring in Urinary Tract Infections

Abstract

We have evaluated the clinical relevance of monitoring acute phase proteins in severe urinary tract infection. Body temperature, white blood cell count, erythrocyte sedimentation rate, serum amyloid A protein (SAA), C-reactive protein (CRP), α-1-antichymotrypsin (ACT) and α-1-acid glycoprotein (AGP) were determined daily in sera from 18 treated patients.

Two patterns of response could be identified: responders and non-responders whose therapy had to be changed. Mean values for each acute phase protein were calculated daily in both responders and non-responders. Statistical evaluation of the significance between the means for each protein was also performed on a daily basis and showed P < 0·01 for SAA and CRP on day 3, for ACT on day 5, and for AGP on day 6.

SAA and CRP appear to be the most reliable markers for antimicrobial therapy monitoring in patients with urinary tract infections.

Keywords

acute phase proteins antimicrobial therapy

References

Asscher

. Interstitial nephritis and urinary tract infection. In: Weatherall

Ledingham

JGG

Warrell

eds. Oxford Textbook of Medicine. 2nd edn. Oxford: Oxford University Press 1987; 18.67–80.

Lipsky

. Urinary tract infection in men. Ann Intern Med 1989; 110: 138–50.

Stamm

Johnson

Stapleton

Roberts

Moseley

Urinary tract infections: From pathogenesis to treatment. J Infect Dis 1989; 159: 400–6.

Morley

Kushner

. Serum C-reactive protein levels in disease. Ann NY Acad Sci 1982; 389: 406–18.

Marhaug

Permin

Husby

. Amyloid related serum protein (SAA) as an indicator of lung infection in cystic fibrosis. Acta Pediatr Scand 1983; 72: 861–6.

Husebekk

Permin

Husby

. Serum amyloid A protein (SAA): An indicator of inflammation in AIDS and AIDS-related complex (ARC). Scand J Infect Dis 1986; 18: 389–94.

Kremer

Wilting

Janssen

. Drug binding to human alpha 1-acid glycoprotein in health and disease. Pharmacol Rev 1988; 40: 1–47.

Dowton

Colten

. Acute phase reactants in inflammation and infection. Semin Hematology 1988; 25: 84–90.

Calvin

Neale

Fotherby

Price

. The relative merits of acute phase proteins in recognition of inflammatory conditions. Ann Clin Biochem 1988; 25: 60–6.

10.

Schultz

Arnold

. Properties of four acute phase proteins: C-reactive protein, serum amyloid A protein, alpha 1-acid glycoprotein and fibrinogen. Semin Arthritis Rheum 1990; 20: 129–47.

11.

Thompson

Milford-Ward

Whicher

. The value of acute phase protein measurements in clinical practice. Ann Clin Biochem 1992; 29: 123–31.

12.

Whicher

Dieppe

. Acute phase proteins. Clin Immunol Allergy 1985; 5: 425–46.

13.

Časl

Grubb

. A rapid enzyme-linked immunosorbent assay (ELISA) for serum amyloid A (SAA) using sequence-specific antibodies. Ann Clin Biochem 1993; 30: 274–82.

14.

Mancini

Carbonara

Heremans

. Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochem 1965; 2: 235–54.

15.

De Beer

Nel

Gie

Donald

Strachan

. Serum amyloid A protein and C-reactive protein levels in pulmonary tuberculosis: Relationship to amyloidosis. Thorax 1984; 39: 196–200.

16.

Schofield

Voulgari

Gozzard

Leyland

Beeching

Stuart

. C-reactive protein concentration as a guide to antibiotic therapy in acute leukaemia. J Clin Pathol 1982; 35: 866–9.

17.

Starke

De Beer

Donnelly

Catovsky

Goldman

Galton

DAG

Serum C-reactive protein levels in the management of infection in acute leukaemia. Eur J Cancer Clin Oncol 1984; 20: 319–25.

18.

Chambers

Whicher

Dieppe

. Acute phase proteins in inflammatory disease. Clin Diagn Lab 1988; 1: 29–37.

19.

Tape

Kisilevsky

. Apolipoprotein A-1 and apolipoprotein SAA half-lives during acute inflammation and amyloidogenesis. Biochim Biophys Acta 1990; 1043: 295–300.

20.

Chelladurai

Macintyre

Kushner

. In vivo studies of serum C-reactive protein turnover in rabbits. J Clin Invest 1983; 71: 604–10.

21.

Horowitz

Volanakis

Briles

. Blood clearance of Streptococcus Pneumoniae by C-reactive protein. J Immunol 1987; 138: 1598–603.