Elevated troponin with renal failure?

  1. 0 Recently left a 12 lead class, instructor stated troponin I and T can be elevated in renal failure pts. When asked how/why, she could not give an answer. Looking at my resources, I cannot find an answer either. Does anyone know why? Any answers are appreciated.
  2. Visit  thelema13 profile page

    About thelema13

    thelema13 has '3' year(s) of experience and specializes in 'ED'. From 'Florida'; Joined Jun '11; Posts: 286; Likes: 364.

    17 Comments so far...

  3. Visit  Esme12 profile page
    10
    it is important to note that cardiac troponins are a marker of all heart muscle damage, not just myocardial infarction. other conditions that directly or indirectly lead to heart muscle damage can also increase troponin levels. severe tachycardia (ie: supraventricular tachycardia) in an individual with normal coronary arteries can also lead to increased troponins for example, presumably due to increased oxygen demand and inadequate supply to the heart muscle or "stretching" of the myocardium from fluid overload (troponin 1) as in the setting of acute renal failure versus troponin t in the setting of chronic renal failure in the prediction of prognosis.

    troponins are also increased in patients with heart failure, where they also predict mortality and ventricular rhythm abnormalities. they can rise in inflammatory conditions such as myocarditis and pericarditis with heart muscle involvement (which myopericarditis). troponins can also indicate several forms of cardiomyopathy, such as dilated cardiomyopathy, hypertrophic cardiomyopathy or (left) ventricular hypertrophy, peripartum cardiomyopathy, takotsubo cardiomyopathy (broken heart syndrome) or infiltrative disorders such as cardiac amyloidosis.

    heart injury with increased troponins also occurs in cardiac contusion, defibrillation and renal failure as well as internal or external cardioversion. increased troponins are commonly increased in several procedures such as cardiac surgery and heart transplantation, closure of atrial septal defects, percutaneous coronary intervention or radiofrequency ablation.

    http://www.uptodate.com/contents/ser...-renal-failure
    Armygirl7, Roy Fokker, ausrnurse, and 7 others like this.
  4. Visit  LadyinScrubs profile page
    2
    It is amazing what a decreasing renal function will do to the body.
    Roy Fokker and turnforthenurseRN like this.
  5. Visit  whichone'spink profile page
    2
    Won't decreased renal function eventually lead to heart failure from all the fluid overload? That's about all I can think of for why troponin I's will be elevated. Same with BNPs.
    emmanewgrad and fromtheseaRN like this.
  6. Visit  LadyinScrubs profile page
    3
    The kidneys - fluid overload, electrolyte problems, cardiac rhythms, low med clearance and risk for toxcity...all a result of acute and chronic renal problems. Get a low GFR and the fun begins.
  7. Visit  Anna Flaxis profile page
    3
    Quote from thelema13
    Recently left a 12 lead class, instructor stated troponin I and T can be elevated in renal failure pts. When asked how/why, she could not give an answer. Looking at my resources, I cannot find an answer either. Does anyone know why? Any answers are appreciated.
    I once asked an experienced interventional cardiologist this question, and even he could not tell me. Last I checked, they don't even know if troponins are renally excreted and whether this might be a cause. Stretching of the myocardium related to fluid overload makes the most sense to me.
  8. Visit  AJPV profile page
    2
    I've just been reading some studies showing that habitual coffee drinking is protective to the kidneys and results in increased GFR over non-coffee drinkers. It results in decreased nephropathy in both non-diabetics and diabetics, and it decreases the incidence of glucose intolerence & type 2 diabetes. I wonder if I can include that among my teaching points.
    Emergent and emmanewgrad like this.
  9. Visit  thelema13 profile page
    0
    Thanks, it makes sense when I think of it from a fluid overload aspect.

    Quote from AJPV
    I've just been reading some studies showing that habitual coffee drinking is protective to the kidneys and results in increased GFR over non-coffee drinkers. It results in decreased nephropathy in both non-diabetics and diabetics, and it decreases the incidence of glucose intolerence & type 2 diabetes. I wonder if I can include that among my teaching points.
    Do you have a source for this? Very interesting...
  10. Visit  AJPV profile page
    1
    Here's a citation for an article I found through our school database. Sorry, I can't post the article since it's copyrighted and our school has a subscription. But you can find lots of similar articles if you google the topic. This article also mentions that habitual coffee intake protects against Parkinson's and liver diseases. I have also read other studies demonstrating a lower risk of several cancers. Seems like this is an area of new interest in the last decade or so.


    Higdon, J. & Frei, B. Coffee and health: a review of recent human research. Critical Reviews in Food Science and Nutrition, vol. 46 (issue 2). Boca Raton: 2006. Pages 101-123.
    Emergent likes this.
  11. Visit  BrandybunsRN profile page
    1
    This is an older article, but it does address some of the other reasons for a troponin bump or leak. Although when it mentions renal it says the reasons are "still under debate".... so I'm sure it's been studied more recently... I just thought this has some nice information.

    http://chestjournal.chestpubs.org/co...25/5/1877.full
    emmanewgrad likes this.
  12. Visit  CraigB-RN profile page
    2
    Armygirl7 and Altra like this.
  13. Visit  athflying profile page
    0
    I work on a renal floor and see renal patients occasionally with elevated troponins. More likely to see on a patient who does CAPD as it isn't as efficient as hemodialysis and tend to carry more fluid.
  14. Visit  rdrcrnawannabe profile page
    1
    Troponin I and T are reliable and preferred markers for cardiac damage in patient population with NORMAL renal function.

    Troponin T (TnT) is typically elevated in chronic renal failure. There are several theories with no strictive measurements on how this is diagnosed. From what I have read, most cardiologists seem to think it is due to myocardial stunning, which produce higher levels of an unbound cytosolic pool of TnT (myocardial stunning is defined as a 20% reduction in segmental wall motion at rest with evidence of recovery after hemodialysis).


    Other theories include left ventricular hypertrophy, endothelial dysfunction, loss of membrane integrity due to the leakage of troponin, ongoing microinfarctions, and sub-slinical cardiac damage exacerbated by reduced renal clearance. Overall, the concentration of TnT is directly related to the GFR/renal clearance.


    Regardless of the cause, studies have shown an increase in mortality in renal failure patients whose troponins are elevated; elevations in TnT are predictors of increased mortality and worsening long term cardiovascular outcomes, especially in the presence of known coronary artery disease. The question remains when to treat elevated troponins in the absence of cardiac-related symptoms; some question the need for more aggressive therapy for atherosclerotic disease or PCI in the asymptomatic patient. Post-ischemic cardiac dysfunction can occur following hemodialysis, so it is recommended to obtain baseline markers prior to this.

    The best advice is to monitor serial troponins and EKG changes; many of ESRD patients have cardiomyopathy in the setting of left ventricular hypertrophy.
    thelema13 likes this.


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