Troponins in ESRD
Troponins in symptomatic patients with suspected ACS
Elevation of troponin t is associated with adverse outcomes in symptomatic patients with suspected ACS, regardless of the degree of renal insufficiency [11]. Troponin t concentrations reach higher peaks and it remains detectable for longer time in patients with advanced renal failure. Repeated early measurements of troponin t are needed to detect a pronounced rise indicating an acute ischaemic episode, as patients with ESRD already have increased troponin irrespective of cardiac event. No protocols have been defined yet on frequency and intervals of blood sampling.
Troponins in asymptomatic patients without suspicion of ACS
It is very difficult to evaluate the results for raised troponin t in asymptomatic patients with ESRD. In ESRD patients cardiovascular disease is the most common cause of death, …show more content…
It was assumed firstly that there is re-expression of troponin in uraemic myopathic muscle. In a study done by McLaurin et al, concluded that presence of troponin t in four out of five biopsies in haemodialysis patients. But no such finding was reported regarding troponin i [49]. But this re-expression hypothesis was proved wrong in several subsequent studies [50,51]. In ESRD patients, decrease in renal clearance of troponin can be taken as the second cause. Co-morbidities such as heart failure, LV hypertrophy causing sub endocardial ishaemia [52] or renal ishaemia with oxygen mismatch in supply and demand can lead to elevation of troponin levels in serum. It is reported recently, that troponins are broken down into very small pieces which can be cleared by kidney [53]. In with CKD these micro fragments are left behind as they are not cleared by damaged kidney, leading to their detection in
Troponins in symptomatic patients with suspected ACS
Elevation of troponin t is associated with adverse outcomes in symptomatic patients with suspected ACS, regardless of the degree of renal insufficiency [11]. Troponin t concentrations reach higher peaks and it remains detectable for longer time in patients with advanced renal failure. Repeated early measurements of troponin t are needed to detect a pronounced rise indicating an acute ischaemic episode, as patients with ESRD already have increased troponin irrespective of cardiac event. No protocols have been defined yet on frequency and intervals of blood sampling.
Troponins in asymptomatic patients without suspicion of ACS
It is very difficult to evaluate the results for raised troponin t in asymptomatic patients with ESRD. In ESRD patients cardiovascular disease is the most common cause of death, …show more content…
It was assumed firstly that there is re-expression of troponin in uraemic myopathic muscle. In a study done by McLaurin et al, concluded that presence of troponin t in four out of five biopsies in haemodialysis patients. But no such finding was reported regarding troponin i [49]. But this re-expression hypothesis was proved wrong in several subsequent studies [50,51]. In ESRD patients, decrease in renal clearance of troponin can be taken as the second cause. Co-morbidities such as heart failure, LV hypertrophy causing sub endocardial ishaemia [52] or renal ishaemia with oxygen mismatch in supply and demand can lead to elevation of troponin levels in serum. It is reported recently, that troponins are broken down into very small pieces which can be cleared by kidney [53]. In with CKD these micro fragments are left behind as they are not cleared by damaged kidney, leading to their detection in