Dialyzability, Protein Binding, and Renal Excretion of Plasma Conjugated Bilirubin*

Fulop, Milford; Sandson, John; Brazeau, Paul

doi:10.1172/jci105179

Cited by 65 publications

(25 citation statements)

References 15 publications

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“…A small portion of plasmaconjugated bilirubin which is not bound to albumin and which is ultrafiltrable is ex creted in urine mainly by glomerular filtra tion [27], In the presence of complete biliary obstruction the urinary excretion of bilirubin even may become quantitatively important [28], In our patients with cirrhosis in whom no complete biliary obstruction was present only minor quantities of bilirubin were ex creted in urine.…”

Section: Discussionmentioning

confidence: 63%

Hepatic Secretion of Bilirubin and Biliary Lipids in Patients with Alcoholic Cirrhosis of the Liver

Raedsch¹,

Stiehl²,

Gundert‐Remy³

et al. 1983

Digestion

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In patients with cirrhosis of the liver elevated bilirubin concentrations in the plasma could be the result of decreased bilirubin excretion or an oveφroduction of bilirubin with insufficient excretion of the increased amounts of bilirubin. Under steady state conditions with constant serum bilirubin concentrations bilirubin synthesis equals biliary and urinary bilirubin excretion. In the present study in 10 healthy volunteers and 11 patients with alcoholic cirrhosis of the liver and serum bilirubin concentrations of 7.0 ± 1.9 mg/dl the biliary excretion of bilirubin was studied by the intestinal perfusion method and compared with the excretion of bile lipids. Biliary excretion of bilirubin in the cirrhotics was 38.7 ± 8.8 μmol/h, the 10 healthy controls excreted 17.9 ± 0.9 μmol/h bilirubin. Only minor amounts of bilirubin were excreted in urine. In 4 of the 11 cirrhotics ⁵¹Cr-red blood cell half-lives were studied revealing ongoing hemolysis. Bilirubin production calculated from red cell life span was identical to biliary excretion of bilirubin with an error less than 5 %. The data indicate that in patients with alcoholic cirrhosis of the liver serum concentrations of bilirubin may be elevated due to oveφroduction of bilirubin and a concomitant decrease of the biliary transport capacity of bilirubin.

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Section: Discussionmentioning

confidence: 63%

Hepatic Secretion of Bilirubin and Biliary Lipids in Patients with Alcoholic Cirrhosis of the Liver

Raedsch¹,

Stiehl²,

Gundert‐Remy³

et al. 1983

Digestion

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“…Although the "pool size" for conjugated bilirubin in serum is difficult to assess, we have made the assumptions that the conjugate is distributed in the same volume (30,31) as serum albumin, to which it is chiefly bound (32), and that there is little diffusion of this polar molecule into the tisues. An error in this assumption would not alter the finding that somewhat more than half the amount of conjugated bilirubin is found in each of these four compartments in heterozygous Gunn rats as compared with normal rats; i.e., that a similar percentage of the total conjugate is recovered in each compartment in both types of animal.…”

Section: Resultsmentioning

confidence: 99%

Bilirubin excretion in rats with normal and impaired bilirubin conjugation: effect of phenobarbital

Robinson¹,

Yannoni²,

Nagasawa³

1971

J. Clin. Invest.

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A B S T R A C T The effect of phenobarbital on bilirubin excretion was studied in rats with different capacities for bilirubin conjugation. Drug treatment induced substantial increases in bilirubin UDP-glucuronyl transferase activity in the liver of both normal and heterozygous Gunn rats, but not homozygous Gunn rats in which enzyme activity is completely absent. However, enhancement of bilirubin excretion in vivo was observed only in heterozygous Gunn rats. In these animals the maximum capacity to excrete bilirubin into bile (T.ax), like the activity of the conjugating enzyme, was half normal; phenobarbital caused an increase in Tmax to levels characteristic of normal animals, with a twofold rise in the excretion of conjugated pigment. This appeared to be largely unrelated to enhancement of bile flow, and there was no stimulation of alternate pathways of bilirubin excretion.Conjugated bilirubin was consistently recovered from the plasma and urine of both untreated normal and heterozygous Gunn rats infused with unconjugated pigment. The quantities thus recovered comprised a similar fraction of the total pigment conjugated in both types of animal. Moreover, there were linear correlations between Tmax and both the rate of bile flow and the activity of the conjugating enzyme over the range of values represented by control rats of both types. These findings suggest that the process by which conjugated bilirubin is secreted into the bile is closely related to conjugation and limits the final excretory rate at different levels of pigment excretion. The phenobarbital effect uniquely

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“…Since the unconjugated bilirubin-albumin complex cannot cross the glomerulus, bilirubin is not found in normal urine; in obstructive jaundice a different situation pertains since approximately 1% of the bilirubin-glucuronide-albumin complex in the plasma is dialysable and can therefore be excreted by glomerular filtration (Fulop, Sandson and Brazeau, 1965). It seems unlikely that tubular secretion or non-ionic diffusion are of importance in the renal excretion of bilirubin but tubular re-absorption may be involved (Ali and Billing, 1966).…”

Section: Bilirubin Metabolismmentioning

confidence: 99%

Bilirubin Metabolism and Jaundice with Special Reference to Unconjugated Hyperbilirubinaemia

Billing

1970

Ann Clin Biochem

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Dialyzability, Protein Binding, and Renal Excretion of Plasma Conjugated Bilirubin*

Cited by 65 publications

References 15 publications

Hepatic Secretion of Bilirubin and Biliary Lipids in Patients with Alcoholic Cirrhosis of the Liver

Hepatic Secretion of Bilirubin and Biliary Lipids in Patients with Alcoholic Cirrhosis of the Liver

Bilirubin excretion in rats with normal and impaired bilirubin conjugation: effect of phenobarbital

Bilirubin Metabolism and Jaundice with Special Reference to Unconjugated Hyperbilirubinaemia

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