Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 May;38(5):990-997.
doi: 10.1016/j.ajem.2019.11.041. Epub 2019 Nov 29.

Interpreting troponin in renal disease: A narrative review for emergency clinicians

Brit Long  1 , Christopher N Belcher  2 , Alex Koyfman  3 , Jonathan M Bronner  4
Affiliations
Review

Interpreting troponin in renal disease: A narrative review for emergency clinicians

Brit Long et al. Am J Emerg Med. 2020 May.

Abstract

Introduction: Patients with chronic kidney disease (CKD)/end stage renal disease (ESRD) can experience several severe complications, including acute coronary syndrome (ACS). While troponin is the biomarker of choice for evaluation of ACS, interpretation of troponin in CKD/ESRD can be challenging.

Objective: This narrative review evaluates troponin elevation in patients with CKD/ESRD, pitfalls in the evaluation with troponin, and an approach to using troponin in these high-risk patients.

Discussion: Patients with CKD/ESRD are at greater risk for ACS and possess higher levels of circulating troponin. Relatedly, these patients often present atypically for ACS. Several pitfalls must be considered in the use of troponin when evaluating for ACS. While troponin elevation in patients with CKD/ESRD is often considered to be due to underlying renal disease, this elevation has several etiologies including uremic skeletal myopathy, microinfarctions, left ventricular hypertrophy (LVH), decreased clearance, and unrecognized congestive heart failure (CHF). Utilizing troponin assays in this patient population requires a nuanced approach, as the sensitivity and specificity for troponin testing in CKD varies. Concern for ACS with elevated troponin warrants treatment for ACS until proven otherwise, with consideration of atypical presentations along with other causes for patient symptoms that may result in troponin elevation.

Conclusions: Patients with CKD/ESRD presenting with symptoms concerning for ACS are challenging. The utilization of troponin assays is important in this population given their high risk of ACS but requires an educated and nuanced approach.

Keywords: Acute coronary disease; Acute myocardial infarction; Biomarker; End stage renal disease; Kidney injury; Troponin.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest None.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

MeSH terms