Elevated troponin with renal failure?

Specialties Emergency

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Specializes in ED.

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.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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/serum-cardiac-enzymes-in-patients-with-renal-failure

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It is amazing what a decreasing renal function will do to the body.

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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.

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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.

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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.

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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. :D

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Specializes in ED.

Thanks, it makes sense when I think of it from a fluid overload aspect.

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. :D

Do you have a source for this? Very interesting...

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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.

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Specializes in Cardiac.

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/content/125/5/1877.full

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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.

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