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.