Origin of Cardiac Troponin T Elevations in Chronic Kidney Disease

Abstract

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Mass Spectrometric Identification of Cardiac Troponin T in Urine of Patients Suffering from Acute Myocardial Infarction

“…Lastly, a recent study from our group showed that impaired renal clearance is not the main driver behind persistently increased cardiac troponin concentrations (8). Although the results presented here may seem to be at odds with that conclusion, it is important to consider that the current study demonstrated that cardiac troponin in urine is limited to AMI patients with high cTnT concentrations in serum (>1000 ng/L) and concomitant proteinuria.…”

“…Nevertheless, the interpretation of cardiac troponin concentrations can be challenging, especially in individuals with persistently increased levels (4,5), like those found in chronic kidney disease patients. The high prevalence of persistently increased cardiac troponin concentrations among individuals with impaired renal function has raised the question if, and if so how, the kidneys are involved in the terminal elimination of cardiac troponins (6)(7)(8). A better understanding of the final elimination of cardiac troponins might help us better interpret cardiac troponin concentrations.…”

Acute Kidney Injury Induces Remote Cardiac Damage and Dysfunction Through the Galectin-3 Pathway

“…Although renal function did affect the level of natriuretic peptides and troponin, eGFR did not appear to be the major determinant of these cardiac biomarker levels (22). Recent data showed similar diurnal variation in patients with and without chronic kidney disease, which suggested that decreased clearance is not the primary mechanism for elevated high-sensitivity cardiac troponin levels in the patients with renal failure (23). Importantly, elevated levels of natriuretic peptides and troponin were associated in many studies with cardiovascular events and outcome 24, 25.…”

High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery

“…Lastly, postoperative cTn elevations may also occur in the presence of acute and chronic kidney disease and injury. Whilst a recent study showed that the origin of cTnT elevations in chronic kidney disease is overwhelmingly cardiac and not impaired renal elimination, 26 this is not clear in acute kidney injury, where impaired renal elimination may be the dominant cause.…”