Evaluating troponin elevation in patients with chronic kidney disease and suspected acute coronary syndrome

Lorenzo Braghieri; Osamah Z. Badwan; Warren Skoza; Maan Fares; Venu Menon

doi:10.3949/ccjm.90a.23012

ABSTRACT

Many patients with chronic kidney disease have chronically elevated cardiac troponin levels, and if they present with symptoms suggesting an acute coronary syndrome, it is often difficult to determine if this is the correct diagnosis. This article briefly reviews the major challenges in diagnosing acute coronary syndrome in patients with chronic kidney disease, describes the mechanisms and prognostic significance of troponin elevation in chronic kidney disease, and provides a diagnostic algorithm to risk-stratify patients with chronic kidney disease who have troponin elevation and suspected acute coronary syndrome.

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Lorenzo Braghieri, MD⇑

Department of Internal Medicine, Cleveland Clinic, Cleveland, OH

Address:
Lorenzo Braghieri, MD, Department of Internal Medicine, NA10, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; braghil{at}ccf.org

Osamah Z. Badwan, MD

Department of Internal Medicine, Cleveland Clinic, Cleveland, OH

Warren Skoza, MD

Department of Internal Medicine, Cleveland Clinic, Cleveland, OH

1974-maan-faresMaan Fares, MD

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

6737-venugopal-menonVenu Menon, MD

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH