TROPONIN-T IN THE DIFFERENTIAL-DIAGNOSIS OF MYOCARDIAL-INFARCTION, RHABDOMYOLYSIS AND RENAL-FAILURE

History and findings: A 30-year-old man in renal failure due to focal sclerosing glomerulonephritis was, after a seizure with subsequent rha bdomyolysis, found to have an increase not only of creatine kinase (CK ) activity (> 100 000 U/l) but also of cardiac troponin T (cTnT) conce ntration in serum (13 mu g/l: normal: < 0.1 mu g/l), in the absence of any cardiac symptoms. Course: Raised concentration of cTnT is known t o occur in patients with renal failure but no cardiac symptoms. In our patient, despite increased creatinine levels, serum cTnT gradually fe ll to normal within 3 weeks, i.e. the raised creatinine played no part in the elevation of cTnT, which in this patient was probably due to c rossreaction between cardiac and skeletal TnT, or transient fresh synt hesis of cTnT in regenerating skeletal musculature. Conclusions: In pa tients with extensive rhabdomyolysis and renal failure the assessment of the clinical status and the EGG, to exclude myocardial infarction, are of crucial importance. The cTnT level by itself is of only limited value in such cases.