Troponins and renal failure

One of the common occurrences is that we have raised troponins in patients with renal impairment.

This sets up all sorts of questions. Is it cardiac? Is it a renal phenomenon?

We simply aren’t sure and the theories to explain the rise aren’t proven.

We know that in patients with renal failure:
-troponin T is raised in about 53%
-troponin I is raised in about 17%

Increased troponin levels in stable renal failure patients, has been associated with a 5 fold increase in short and long term death.

This has been demonstrated in various studies. Circulation 2005;112:3088-3096 identified a moderate to large risk of cardiac death with elevated troponin T in asymptomatic end stage renal disease patients.

So, what do we do?

Firstly we need to do serial Troponins to establish a baseline. Secondly, these are the patients that benefit from a CK and CKMB
as these DO NOT rise unless there is cardiac injury.

Peter Kas