All About Bilirubin in Urine

What is Bilirubin in urine or Bilirrubina que es?

Bilirubin is a yellowish pigment produced during your body’s routine red blood cell breakdown process. If your liver is functioning properly, it will process and remove bilirubin from the body through your intestine. Bilirubinuria or bilirubin in the urine (Spanish: Bilirrubina, often misspelled as bilirubina) is the first clinical indication of liver disorder.

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The appearance of bilirubin in the urine means all is not well with your liver.

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How does your liver process bilirubin?

Bilirubin, when released into blood circulation, binds with a transport protein (albumin) and reaches your liver. In the liver, it undergoes certain chemical processes before being secreted into bile, a fluid that helps in digestion. Bile drains bilirubin to the small intestine, from where it is excreted out of the body with stool. The peculiar yellow color of the stool is due to bilirubin.

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How is bilirubin in urine related to your health?

Your liver is responsible for regulating bilirubin levels in your blood and urine. The liver makes sure that most of the bilirubin is removed from your body. Low bilirubin levels are not a matter of concern. But if your liver is not working properly, it results in elevated bilirubin levels in your blood which eventually gets excreted in your urine. The detection of bilirubin in urine is thus an indication of liver disorder.

What causes Bilirubin in urine?

Bilirubin has two different forms: indirect or unconjugated bilirubin and direct or conjugated bilirubin. Before being processed by the liver, the indirect bilirubin in the bloodstream remains unconjugated, that is, water-insoluble. That means your kidneys cannot excrete it in the urine.

The liver converts the unconjugated bilirubin into water-soluble or conjugated bilirubin. This is called direct bilirubin, the one that normally drains into the intestine and is eventually flushed out of your body. So it is not normal for direct bilirubin to be found in the urine. The leakage of the conjugated bilirubin into circulation and its excretion in urine occurs either due to bile duct obstruction or liver damage.

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When does a bilirubin in urine test become necessary?

High or low bilirubin levels in urine are measured through a urine test. A urine bilirubin test becomes necessary if you experience symptoms of liver disorder, gallbladder disease, or biliary obstruction: Some of these symptoms are:

• Abdominal pain and/or swelling
• Appetite and weight loss
• Nausea and vomiting
• Fatigue and exhaustion
• Yellowing of skin and eyes (jaundice)
• Dark urine and pale stool
• Swelling of legs and feet

Timely intervention, beginning with a bilirubin in urine test, is crucial as soon as you experience these symptoms.

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How can I test bilirubin in urine?  

You can check your urine bilirubin levels using urine test strips. Urine dipstick tests consist of narrow urinalysis strips with reagent pads that change color if bilirubin is detected in urine. The color of the test pad is compared against a bilirubin color chart that provides an estimate of the saturation of bilirubin in urine.

It is important that you use only a reliable dipstick test that guarantees clinical-grade accuracy.  

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How do I read and interpret bilirubin in urine test strips?

At-home bilirubin in urine dipstick test is easy to perform. Urinalysis kits are user-friendly and contain step-by-step instructions to guide you through. Here are some easy steps for you to follow:

1. Dip a urine test strip into the urine sample
2. Wait for the specified time as instructed
3. Within 30 seconds, match the shade/color of the test pad with the corresponding color chart

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If the reagent pad shows any shade of white or cream, your urine bilirubin test is negative. It is one of the signs of a healthy liver. On the contrary, if the pad changes color to peach, brown, or reddish-brown, it indicates a positive result. Darker shades signify higher bilirubin levels. Scientific data and clinical practice suggest that bilirubin in urine indicates a liver condition.

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What are the normal and elevated levels of bilirubin?

Direct bilirubin is not detectable in the urine of a healthy individual. It is normal to have a bilirubin concentration of 1.7-5.1 μmol/L (SI units) in the urine of an adult/elderly. A dipstick test can efficiently detect elevated ranges of bilirubin in the urine. These above-normal levels are:

• Small:  17 μmol/L
• Moderate: 50 μmol/L
• Large: 100 μmol/L

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How should I proceed if I have high bilirubin levels in the urine?

High levels of direct bilirubin in urine may indicate a problem in your liver or gallbladder. Ideally, you should simultaneously test urobilinogen and bilirubin levels in the urine for a thorough liver health assessment. It is strongly recommended to monitor these two liver-health parameters regularly if you are at risk of liver disease. In case your readings are not normal, seek expert medical advice immediately. Your doctor may then advise other tests, including a liver panel and a group of blood tests, for a definitive diagnosis related to your overall liver function. Equally important for your liver health recovery is the adoption of healthy dietary practices. You can find some excellent advice on liver health diets here.