Prolonged half-life of albumin-bound conjugated explains 2 previously unexplained

enigmas in jaundiced patients with liver disease

Some patients with conjugated hyperbilirubinemia do not exhibit bilirubinuria during

recovery phase of disease because bilirubin is bound to albumin and not filtered by
renal glomeruli

Elevated serum bilirubin level declines more slowly than expected in some patients who
otherwise appear to be recovering satisfactorily

Late in recovery phase of hepatobiliary disorders, all conjugated bilirubin may be in

albumin-linked form

Value in serum falls slowly because of long half life of albumin

Look what is the fraction predominating

Never ask for total bilirubin only

Urine Bilirubin

Bilirubinuria

Implies presence of liver disease

Conjugated bilirubin

Filtered by glomerulus

Majority is reabsorbed by proximal tubules

Small fraction is excreted in urine

Unconjugated bilirubin

Always bound to albumin in serum

Not filtered by kidneys

Not found in urine