The significance of serum troponin T in patients with kidney disease: a review of the literature

Ann Clin Biochem 2004;41:1-9
doi:10.1258/000456304322664645
© 2004 Association for Clinical Biochemistry

 

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Edmund J. Lamb,
Michelle C. Webb and
Nasir A. Abbas


Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Canterbury CT1 3NG, UK;
East Kent Hospitals NHS Trust Kent and Canterbury Hospital Canterbury CT1 3NG, UK;
East Kent Hospitals NHS Trust Kent and Canterbury Hospital Canterbury CT1 3NG, UK

The last 10 years have witnessed radical changes in the definitionand diagnosis of the acute coronary syndrome (ACS), includingmyocardial infarction, as a result of the introduction of sensitiveand specific markers of myocardial damage, the cardiac troponins.One barrier to the universal acceptance of these markers hasbeen the observation that troponin T (cTnT) concentration iscommonly increased in the presence of renal failure. Initiallyit was believed that this constituted an important false positivelimitation of the test. This was confounded by problems withthe initial cTnT assay and by the observation that troponinI (cTnI) was generally not increased in these patients. However,it has recently been demonstrated that the prognostic significanceof a raised cTnT concentration in patients with a suspectedACS is unaffected by renal impairment. Further, powerful outcomestudies are now being reported demonstrating that raised concentrationsof serum cTnT are predictive of mortality in haemodialysis patients.This review summarizes our current understanding of the prevalenceand significance of raised serum cTnT concentrations in patientswith kidney disease and highlights areas where our understandingis incomplete. Evidence suggests that raised troponin concentrationsin uraemic patients do indeed reflect myocardial injury. Inthe future, patients demonstrating this abnormality may be thetarget for more aggressive cardiac intervention, the advantagesof which have been demonstrated in the non-uraemic population.

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