Mechanism of bilirubin elimination in urine: insights and prospects for neonatal jaundice
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Mercy Thomas
, Winita Hardikar
, David G. Tingay
Abstract
Despite a century of research, bilirubin metabolism and the transport mechanisms responsible for homeostasis of bilirubin in serum remain controversial. Emerging evidence on the hepatic membrane transporters and inherited disorders of bilirubin metabolism have contributed to a greater understanding of the various steps involved in bilirubin homeostasis and its associated excretory pathways. We discuss these recent research findings on hepatic membrane transporters and evaluate their significance on the newborn bilirubin metabolism and excretion. New insights gained speculate that a proportion of conjugated bilirubin is excreted via the renal system, as an alternative to the intestinal excretion, even in normal physiological jaundice with no associated pathological concerns. Finally, this paper discusses the clinical relevance of targeting the altered renal excretory pathway, as bilirubin in urine may hold diagnostic importance in screening for neonatal jaundice.
Funding source: National Health and Medical Research Council (NHMRC)
Award Identifier / Grant number: GNT1139340
Funding source: Victorian Government Operational Infrastructure Support Program
Funding source: NHMRC Early Career Fellowship
Award Identifier / Grant number: GNT1123030
Funding source: University of Melbourne
Funding source: National Health and Medical Research Council Clinical Career Development Fellowship
Award Identifier / Grant number: 1053889
Acknowledgments
The authors wish to thank Mr Blake D’Souza for his support in drawings of bilirubin metabolism (Figure 1).
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Research funding: This study is supported by a National Health and Medical Research Council (NHMRC) Development Grant (GNT1139340) and the Victorian Government Operational Infrastructure Support Program (Melbourne, Australia). AER is supported by an NHMRC Early Career Fellowship (GNT1123030). MT is supported by an RTP scholarship governed by the University of Melbourne. DGT is supported by a National Health and Medical Research Council Clinical Career Development Fellowship (Grant ID 1053889).
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Author contributions: MT and AER developed the concept of the manuscript. MT prepared the first draft under the supervision of AER and RG. WH and DT contributed their expertise in hepatology and neonatology, respectively, in reviewing the manuscript. TPL contributed his expertise in reviewing the clinical chemistry of bilirubin and overall structure of the manuscript. MT reviewed and screened the included references. All authors contributed to the re-drafting of the manuscript.
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Competing interests: None of the authors have any financial interests or conflicts of interest to declare. The members of the team are involved in the development of a method of detecting jaundice in neonates using a urine-based testing system.
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© 2021 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- COVID-19: which lessons have we learned?
- Review
- Global FT4 immunoassay standardization: an expert opinion review
- Mini Review
- Mechanism of bilirubin elimination in urine: insights and prospects for neonatal jaundice
- Opinion Paper
- Laboratory medicine in the COVID-19 era: six lessons for the future
- EFLM Paper
- How to meet ISO15189:2012 pre-analytical requirements in clinical laboratories? A consensus document by the EFLM WG-PRE
- General Clinical Chemistry and Laboratory Medicine
- External quality assessment of M-protein diagnostics: a realistic impression of the accuracy and precision of M-protein quantification
- Error simulation modeling to assess the effects of bias and precision on bilirubin measurements used to screen for neonatal hyperbilirubinemia
- NT-proBNP levels in preeclampsia, intrauterine growth restriction as well as in the prediction on an imminent delivery
- Serum N-glycan fingerprint nomogram predicts liver fibrosis: a multicenter study
- Hematology and Coagulation
- Performance of digital morphology analyzer Vision Pro on white blood cell differentials
- Cardiovascular Diseases
- Prognostic implication of elevated cardiac troponin I in patients visiting emergency department without diagnosis of coronary artery disease
- Relationships between renal function variations and relative changes in cardiac troponin T concentrations based on quantile generalized additive models (qgam)
- Diabetes
- Association of hemoglobin H (HbH) disease with hemoglobin A1c and glycated albumin in diabetic and non-diabetic patients
- Comparative study of i-SENS glucometers in neonates using capillary blood samples
- Infectious Diseases
- Evaluation of four commercial, fully automated SARS-CoV-2 antibody tests suggests a revision of the Siemens SARS-CoV-2 IgG assay
- Vitamin-D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients
- Does mid-regional pro-adrenomedullin (MR-proADM) improve the sequential organ failure assessment-score (SOFA score) for mortality-prediction in patients with acute infections? Results of a prospective observational study
- Letters to the Editors
- Global FT4 immunoassay standardization. Response to: Kratzsch J et al. Global FT4 immunoassay standardization: an expert opinion review
- Free-thyroxine standardization: waiting for Godot while well serving our patients today
- Prevalence of SARS-CoV-2 antibodies in health care personnel of two acute care hospitals in Linz, Austria
- Pediatric evaluation of clinical specificity and sensitivity of SARS-CoV-2 IgG and IgM serology assays
- Prevention and control of COVID-19 in the penitentiary of Florence
- Pooling for SARS-CoV-2-testing: comparison of three commercially available RT-qPCR kits in an experimental approach
- Very high SARS-CoV-2 load at the emergency department presentation strongly predicts the risk of admission to the intensive care unit and death
- Next-generation sequencing and RT-PCR to identify a 32-day SARS-CoV-2 carrier
- 25-Hydroxyvitamin D concentrations in COVID-19 patients hospitalized in intensive care unit during the first wave and the second wave of the pandemic
- Laboratory findings in a child with SARS-CoV-2 (COVID-19) multisystem inflammatory syndrome
- Discrepant cardiac troponin results in a young woman
- Response to: towards the rational utilization of SARS-CoV-2 serological tests in clinical practice
- Congress Abstract
- 12th National Scientific Congress SPML,29–31 October 2020, Online, Portugal
Artikel in diesem Heft
- Frontmatter
- Editorial
- COVID-19: which lessons have we learned?
- Review
- Global FT4 immunoassay standardization: an expert opinion review
- Mini Review
- Mechanism of bilirubin elimination in urine: insights and prospects for neonatal jaundice
- Opinion Paper
- Laboratory medicine in the COVID-19 era: six lessons for the future
- EFLM Paper
- How to meet ISO15189:2012 pre-analytical requirements in clinical laboratories? A consensus document by the EFLM WG-PRE
- General Clinical Chemistry and Laboratory Medicine
- External quality assessment of M-protein diagnostics: a realistic impression of the accuracy and precision of M-protein quantification
- Error simulation modeling to assess the effects of bias and precision on bilirubin measurements used to screen for neonatal hyperbilirubinemia
- NT-proBNP levels in preeclampsia, intrauterine growth restriction as well as in the prediction on an imminent delivery
- Serum N-glycan fingerprint nomogram predicts liver fibrosis: a multicenter study
- Hematology and Coagulation
- Performance of digital morphology analyzer Vision Pro on white blood cell differentials
- Cardiovascular Diseases
- Prognostic implication of elevated cardiac troponin I in patients visiting emergency department without diagnosis of coronary artery disease
- Relationships between renal function variations and relative changes in cardiac troponin T concentrations based on quantile generalized additive models (qgam)
- Diabetes
- Association of hemoglobin H (HbH) disease with hemoglobin A1c and glycated albumin in diabetic and non-diabetic patients
- Comparative study of i-SENS glucometers in neonates using capillary blood samples
- Infectious Diseases
- Evaluation of four commercial, fully automated SARS-CoV-2 antibody tests suggests a revision of the Siemens SARS-CoV-2 IgG assay
- Vitamin-D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients
- Does mid-regional pro-adrenomedullin (MR-proADM) improve the sequential organ failure assessment-score (SOFA score) for mortality-prediction in patients with acute infections? Results of a prospective observational study
- Letters to the Editors
- Global FT4 immunoassay standardization. Response to: Kratzsch J et al. Global FT4 immunoassay standardization: an expert opinion review
- Free-thyroxine standardization: waiting for Godot while well serving our patients today
- Prevalence of SARS-CoV-2 antibodies in health care personnel of two acute care hospitals in Linz, Austria
- Pediatric evaluation of clinical specificity and sensitivity of SARS-CoV-2 IgG and IgM serology assays
- Prevention and control of COVID-19 in the penitentiary of Florence
- Pooling for SARS-CoV-2-testing: comparison of three commercially available RT-qPCR kits in an experimental approach
- Very high SARS-CoV-2 load at the emergency department presentation strongly predicts the risk of admission to the intensive care unit and death
- Next-generation sequencing and RT-PCR to identify a 32-day SARS-CoV-2 carrier
- 25-Hydroxyvitamin D concentrations in COVID-19 patients hospitalized in intensive care unit during the first wave and the second wave of the pandemic
- Laboratory findings in a child with SARS-CoV-2 (COVID-19) multisystem inflammatory syndrome
- Discrepant cardiac troponin results in a young woman
- Response to: towards the rational utilization of SARS-CoV-2 serological tests in clinical practice
- Congress Abstract
- 12th National Scientific Congress SPML,29–31 October 2020, Online, Portugal