Increased serum amyloid A and urinary kidney injury marker-1 concentrations in cats with pyelonephritis: a diagnostic accuracy study.

Serum amyloid A at 49.1 mg/L threshold highly accurate for diagnosing feline pyelonephritis.

This diagnostic accuracy study evaluated biomarkers for feline pyelonephritis in 71 cats (22 with pyelonephritis, 35 with other urological conditions, 14 healthy controls). Serum amyloid A (SAA) demonstrated excellent discriminatory potential, with a threshold of 49.1 mg/L yielding 95% sensitivity and 97% specificity for differentiating pyelonephritis from other conditions. The positive likelihood ratio of 32 substantially outperformed neutrophil:lymphocyte and monocyte:lymphocyte ratios. SAA normalized in 12 of 14 treated cats during follow-up, supporting its use as a treatment response marker. Urinary kidney injury marker-1 (KIM-1) was elevated in over 50% of pyelonephritis and ureteral obstruction cases, indicating proximal tubular injury, but showed variable patterns during follow-up. The authors conclude that SAA is a highly accurate biomarker for improving diagnostic precision in feline pyelonephritis and supporting timely therapeutic decisions. While KIM-1 effectively identifies tubular injury, its clinical significance requires further investigation.

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