Urine Bilirubin

Aka: Urine Bilirubin, Urobilinogen

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II. Background

  1. Bilirubin testing on the Urine Dipstick reflects tests for 2 different related compounds
  2. Conjugated Bilirubin
    1. Unconjugated Bilirubin is not soluble in water and is not found in the urine
    2. Conjugated Bilirubin is excreted in the stool under normal conditions
    3. Conjugated Bilirubin is an abnormal finding in the urine and reflects liver disease (or False Positive)
    4. Ictotest can be run as a confirmatory test for urine Conjugated Bilirubin
  3. Urobilinogen
    1. Relatively small amount of Bilirubin is converted to Urobilinogen in the intestinal tract and renally excreted
    2. Large amounts of Urobilinogen suggest hepatic disease or Hemolysis

III. Causes: Urine Conjugated Bilirubin

  1. True Positive Test
    1. Biliary tract obstruction
    2. Hepatitis
      1. Viral Hepatitis
      2. Toxic Hepatitis
      3. Drug Induced Hepatitis
  2. Confirmatory Findings of Positive Test
    1. Ictotest Positive
    2. Gross urine findings if Conjugated Bilirubin present
      1. Dark Urine with yellow foam
      2. Sediment elements may be stained
  3. False Positive Bilirubin (Ictotest Negative)
    1. Chlorpromazine (Thorazine)
    2. Phenazopyridine (Pyridium)
  4. False Negative Bilirubin
    1. Selenium
    2. Vitamin C
    3. Prolonged light exposure

IV. Causes: Urobilinogen

  1. True Positive Urobilinogen
    1. Trace or Small Urobilinogen may be a normal finding
    2. Hepatitis
    3. Liver disease
      1. Cirrhosis
      2. Liver Metastases
      3. Liver infarction
    4. Hemolytic Jaundice
  2. False Positive Urobilinogen
    1. Phenazopyradine (Pyridium)
    2. Sulfonamides
  3. False Negative Tests
    1. Inadequate urine sample storage
    2. Preservatives present in urine sample

V. References

  1. Hitzeman (2022) Am Fam Physician 106(1): 27-35 [PubMed]
  2. Simerville (2005) Am Fam Physician 71(6): 1153-62 [PubMed]

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Related Studies

Ontology: Urobilinogen (C0042052)

Definition (MSH) A colorless compound formed in the intestines by the reduction of bilirubin. Some is excreted in the feces where it is oxidized to urobilin. Some is reabsorbed and re-excreted in the bile as bilirubin. At times, it is re-excreted in the urine, where it may be later oxidized to urobilin.
Concepts Biologically Active Substance (T123) , Organic Chemical (T109)
MSH D014558
SnomedCT 44079009
LNC LP15942-3, MTHU003204
English 21H-Biline-8,12-dipropanoic acid, 2,17-diethyl-1,4,5,10,15,16,19,22,23,24-decahydro-3,7,13,18-tetramethyl-1,19-dioxo-, Urobilinogen [Chemical/Ingredient], urobilinogens, urobilinogen, Urobilinogen, UBG - Urobilinogen, UROB - Urobilinogen, Urobilinogen (substance), Urobilinogen, NOS
Swedish Urobilinogen
Czech urobilinogen
Finnish Urobilinogeeni
Russian UROBILINOGEN, УРОБИЛИНОГЕН
Polish Urobilinogen
Spanish urobilinógeno (sustancia), urobilinógeno, Urobilinógeno
French Urobilinogène
German Urobilinogen
Italian Urobilinogeno
Portuguese Urobilinogênio
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Bilirubin in urine (C0555166)

Concepts Laboratory or Test Result (T034)
SnomedCT 275778006, 144738003, 167514002, 273691000009105
English Urine bilirubin, Urine bilirubin level, Bilirubin in urine, Finding of bilirubin in urine, urine bilirubin, bilirubin in urine, (Urine bilirubin) or (bilirubin in urine) (procedure), (Urine bilirubin) or (bilirubin in urine), Bilirubinuria, Bilirubin levels in urine above normal, Bilirubin levels in urine above normal (finding), Finding of bilirubin in urine (finding), Bilirubin in urine - finding
Italian Bilirubinuria
Japanese ビリルビン尿, ﾋﾞﾘﾙﾋﾞﾝﾆｮｳ
Czech Bilirubinurie
Hungarian bilirubinuria
Spanish bilirrubina en orina - hallazgo (hallazgo), bilirrubina en orina - hallazgo, Bilirrubinuria
Portuguese Bilirrubinúra
Dutch bilirubinurie
French Bilirubinurie
German Bilirubinurie
Derived from the NIH UMLS (Unified Medical Language System)

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