Normal sulfobromophthalein retention in established liver disease.

Abstract

The aim of this investigation was to quantify individual indices of sulfobromophthalein (BSP) transport and metabolism in patients with documented liver disease and normal results of the standard BSP retention tests. With the use of bolus-injection and constant-infusion technics, the kinetics of BSP removal were elucidated by determinations reflecting the hepatic functions of uptake, conjugation, storage, and transport maximum (Tm) for biliary excretion. The results in 5 patients with hemochromatosis, 9 with Wilson's disease, and 6 with portal cirrhosis, all with normal BSP retention, were compared with results in 12 cirrhosis patients with abnomal BSP retention and 29 control subjects without clinical or laboratory evidence of liver disease. Among the patients with normal BSP retention, fractional clearance and storage were significantly decreased (p<0.02), whereas Tm and conjugation were normal. Normal results of standard BSP retention tests in established liver disease are sometimes explained as being caused by the dilution effect of an expanded plasma volume, as previously reported. The present investigation has delineated another mechanism, wherein the hepatic injury is such that, with mild impairment of uptake and storage, maintenance of normal Tm was sufficient for the efficient removal of BSP.