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Received on October 19, 2005
Accepted on December 16, 2005
Article |
1 Department of Clinical Biochemistry, Southend Hospital, Westcliff-on-Sea, United Kingdom
2 Department of Renal Medicine, Southend Hospital, Westcliff-on-Sea, United Kingdom
3 Department of Renal Medicine, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Canterbury, United Kingdom
4 Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Canterbury, United Kingdom
* To whom correspondence should be addressed. E-mail: edmund.lamb{at}ekht.nhs.uk.
Background: The clinical significance of the increased concentrations of cardiac troponins observed in patients with end stage renal disease (ESRD) in the absence of an acute coronary syndrome (ACS) is controversial. One proposed explanation is that immunoreactive fragments of cardiac troponin T (cTnT) accumulate in ESRD. We used gel-filtration chromatography (GFC) to ascertain whether fragments of cTnT, which could cross-react in the commercial diagnostic immunoassay (Roche Diagnostics), were the cause of the increased cTnT in the serum of patients with ESRD.
Methods: We subjected sera from ESRD patients (n = 21) receiving dialysis and having increased cTnT concentrations to size-separation GFC. We detected cTnT in the chromatography fractions by use of the same antibodies used in the commercial assay for serum cTnT.
Results: In all patients, cTnT immunoreactivity eluted as a major, homogeneous peak in an identical position between the peaks of serum prolactin [relative molecular mass (Mr) 23 000] and albumin (Mr 67 000): the elution pattern of cTnT in samples obtained from ACS patients was identical to that of the ESRD patients. There was no evidence that low-molecular-mass (Mr <23 000) cTnT fragments were the cause of the increased cTnT in the patients studied.
Conclusions: The form of cTnT observed in the serum of patients with kidney failure and immunoreactive in the diagnostic assay is predominantly the free intact form, as in patients with ACS. Our data are consistent with the view that circulating cTnT in renal failure reflects cardiac pathology.
The following articles in journals at HighWire Press have cited this article:
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M. N. Fahie-Wilson, E. M. Hall, and E. J. Lamb The authors of the article cited above respond: Clin. Chem., December 1, 2006; 52(12): 2307 - 2309. [Full Text] [PDF]
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