Chronic Troponin Elevation in CKD — RACP Adult Medicine MCQ

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ModerateCardiologyChronic Troponin Elevation in CKDRACP Adult Medicine

A 75-year-old woman with CKD stage 4 (eGFR 22) presents with atypical chest pain. Troponin I is 45 ng/L (99th percentile ULN 26 ng/L). Serial troponin at 0 and 3 hours shows 45 → 48 ng/L (no significant rise/fall pattern, delta <20%). ECG is unchanged from previous. She has no new wall motion abnormality on echo. What is the most likely interpretation?

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Correct answer: A — Chronic troponin elevation due to CKD

Mildly elevated but stable troponin (no significant rise/fall on serial testing) in CKD without ischaemic ECG changes or wall motion abnormalities represents chronic troponin elevation due to structural heart disease and reduced renal clearance. This is NOT acute MI (which requires a rise/fall pattern). High-sensitivity troponin assays frequently show chronic elevation in CKD stage 3-5.

Reference: CSANZ – 2025 – ACS Guidelines; 4th Universal Definition of MI 2018