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Bilirubin

Urine Analysis Biomarker

Sample Needed

Collection Type: Blood

Body System

Related System: Urine Analysis

Overview

Bilirubin in a urine analysis detects conjugated (direct) bilirubin that has been processed by the liver and is water-soluble. Bilirubin itself is produced by breakdown of heme from red blood cells; unconjugated bilirubin is lipid-soluble and not normally excreted in urine. A urine bilirubin test measures whether conjugated bilirubin is being excreted in urine, which suggests liver dysfunction or obstruction of bile flow. Presence may point to hepatitis, cirrhosis, cholestasis, or bile duct obstruction; absence of urine bilirubin with clinical jaundice suggests hemolytic causes. Symptoms prompting testing include jaundice, dark urine, pale stools, abdominal pain, itching, or unexplained fatigue. Newborn physiology and some medications can alter results; age and pregnancy may change risk for hepatobiliary disease.

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Test Preparation

No special preparation is required

Why Do I Need This Test

Profile: Urine analysis (part of routine urinalysis or liver evaluation) - Symptoms: jaundice, dark urine, pale stools, right-upper-quadrant pain, unexplained malaise/itching - Conditions: hepatitis, cholestasis, bile duct obstruction, cirrhosis, certain drug-induced liver injuries - Reasons for abnormal levels: conjugated hyperbilirubinemia from hepatocellular injury or obstructed bile flow - Biological meaning: urine bilirubin indicates conjugated bilirubin in blood and impaired biliary excretion - Lifestyle/family: heavy alcohol use, hepatotoxic drugs, and family history of inherited cholestatic or biliary disorders increase need for testing

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Understanding Test Results

A normal urine bilirubin is negative/not detectable.
Any detectable bilirubin in urine is abnormal and implies conjugated (direct) hyperbilirubinemia from cholestasis or hepatocellular dysfunction.
In practice, urine bilirubin commonly appears once serum conjugated bilirubin rises above roughly ~2 mg/dL, though thresholds vary.
Trace or low-positive urine bilirubin suggests mild cholestasis or early hepatic injury; moderate-to-high positives suggest significant obstruction (e.g., bile duct stone, tumor) or progressive liver disease and warrant urgent evaluation.
Absence of urine bilirubin despite jaundice suggests hemolytic jaundice (predominantly unconjugated bilirubin).
Be aware of false negatives (high vitamin C, prolonged specimen storage, light exposure) and false positives from oxidizing agents or highly concentrated urine.
Further testing (serum total and direct bilirubin, liver enzymes, imaging) is required to determine cause and severity.

Normal Range

Negative (not detectable) OR <0.2 mg/dL OR <3.4 μmol/L

FAQs

Q: What happens if bilirubin is high?

A: High bilirubin causes jaundice—yellowing of the skin and eyes—plus dark urine, pale stools, itching, fatigue and abdominal pain. It signals problems such as liver disease, bile-duct obstruction or excessive red-cell breakdown. In newborns, very high levels can cause brain injury (kernicterus). Evaluation and prompt treatment are essential to address underlying causes and prevent complications.

Q: Can drinking a lot of water lower bilirubin?

A: Drinking plenty of water supports liver and kidney function and can prevent concentration of blood components, but it does not directly or reliably lower elevated bilirubin caused by liver disease, bile duct obstruction, or hemolysis. Hydration may help mildly in benign situations (for example, mild neonatal dehydration), but significant or persistent jaundice requires medical evaluation and treatment of the underlying cause.

Q: What is the normal range of bilirubin?

A: Normal total bilirubin in adults is about 0.1–1.2 mg/dL (1.7–20.5 µmol/L). Direct (conjugated) bilirubin is usually 0–0.3 mg/dL (0–5 µmol/L); indirect (unconjugated) is the remainder. Newborns commonly have higher levels in the first days (physiological jaundice may reach ~12 mg/dL), so interpretation depends on age and clinical context. Always correlate with symptoms and liver tests.

Q: What is bilirubin in babies?

A: Bilirubin is a yellow pigment produced when the body breaks down old red blood cells. Newborns often have higher bilirubin because their immature livers cannot clear it quickly, causing jaundice (yellow skin and eyes). Most neonatal jaundice is mild and resolves with feeding and time, but very high levels need monitoring and sometimes phototherapy to prevent rare brain injury.

Q: How to reduce bilirubin?

A: Reduce bilirubin by treating the underlying cause: for newborns, timely phototherapy or exchange transfusion as advised by a clinician; for adults, diagnose and manage liver disease, hemolysis, or biliary obstruction. Supportive measures: stay hydrated, avoid alcohol and hepatotoxic drugs, maintain nutrition and rest. Follow prescribed treatments (eg, antivirals or ursodeoxycholic acid when indicated) and seek specialist evaluation for persistent or worsening jaundice.

Q: Can high bilirubin cause damage?

A: High bilirubin itself is often harmless when mildly elevated, but very high or prolonged levels can cause harm. In newborns, severe hyperbilirubinemia risks brain injury (kernicterus) and requires urgent treatment. In adults, persistent high bilirubin usually signals underlying liver or biliary disease and can reflect or contribute to liver damage and complications. Prompt medical evaluation and treatment are important.