Bilirubin in Urine

Bilirubin is a yellowish to brownish pigment found in the bile and produced by the liver. It is a by-product of the breakdown of red blood cells.

A normal healthy body can pass out the body during the digestive process. Bilirubin is not a bad thing. It only becomes alarming when it is accumulated in the bloodstream. If the bilirubin gets out of control, it could lead to jaundice (yellowish discoloration of the skin), which could be an indicator of a liver disease. ^{(1, 10)}

The level of bilirubin is affected by the age and general health condition of the patient. The bilirubin level is checked during urinalysis. The presence of bilirubin in urine is medically known as bilirubinuria. The presence of bilirubin in urine is usually associated with liver and gallbladder disease. A bilirubin in urine normal range does not possess any health risk but once grows out of control can be extremely fatal.

There are two types of bilirubin in blood: unconjugated and conjugated bilirubin. Unconjugated bilirubin binds with other proteins while conjugated bilirubin is free and can pass in various parts of the body including the liver. It passes to the small intestines and will then reach the large intestines giving the stool its distinct color.

A small quantity of bilirubin reaches the kidney and will be eventually excreted through urination. It is the reason why the urine has a straw color. ^{(1, 2)}

Photo 1: A comparison image of a normal urine and a urine with a high level of bilirubin.
Picture Source: healthsaline.com

Picture 2: An image of bilirubin crystals.
Photo Source: healthsaline.com

Image 3: A comparison image of a bilirubin test using two different samples: blood and urine.
Picture Source: laboratorytests.net

Bilirubin in urine symptoms

• Dark yellow colored urine
• Yellowish discoloration of the skin including the eyes and nail beds
• Fatigue
• Nausea with or without vomiting ^{(3, 4)}

A moderate bilirubin in urine is also known as hyperbilirubinemia. What causes bilirubin in urine? A bilirubin is usually conjugated in the liver and will then become water soluble. The bilirubin found in the urine is the unconjugated type. It is not soluble in the water, which means that the kidney cannot filter it. Bilirubin in the urine is indicative of the presence of conjugated hyperbilirubinemia. ⁽⁵⁾

Elevated level of bilirubin in infants

Too much bilirubin in infants could lead to jaundice. Before the infant is born, there are various forms of haemoglobin in the body. The moment an infant is born, the old haemoglobin breaks rapidly, which leads to a high level of bilirubin. The body should be able to get rid of bilirubin through excretion.

The problem with infants is that they have underdeveloped liver, which means that it cannot thoroughly filter out the bilirubin. This causes the level of bilirubin in the blood to rise. Infants at risk for high bilirubin in the blood include premature infant, breast-fed infants, bruising during birth, and those with ABO incompatibility. ^{(6, 8, 9)}

Bilirubin in urine during pregnancy

If the bilirubin level is high during pregnancy, it is an indicator that the red blood cells are not working properly. Pregnant women with high level of bilirubin should be constantly checked for any alarming health conditions such as hepatitis, gallbladder disease, and other forms of infections.

Bilirubin Urine Test

The presence of bilirubin can be checked through a urine test. A bilirubin urine test strips are readily available over the counter and can be purchased even without the doctor’s prescription. The urine strip allows you to conduct bilirubin test right in the comfort of your home.

What causes bilirubin in urine?

1. Hepatitis – It is the inflammation of the liver causing the number of bilirubin to rise. Inflammation of the liver is a result of bacterial, parasitic, or viral attack. An inflamed liver left untreated could lead to liver cirrhosis. Inflammation of the liver can also be caused by autoimmune disorders such as type 1 diabetes mellitus, hyperactive thyroid, rheumatoid arthritis, and Grave’s disease. ⁽⁹⁾
2. Ulcerative colitis – This condition causes an increase in the level of bilirubin.
3. Obstruction of the gallbladder – There are various reasons why the gallbladder is obstructed, but the primary reason is the presence of stone. This leads to the accumulation of bilirubin wherein some of them can be detected in the urine.
4. Bile duct narrowing – It is caused by inflammatory disease or a result of surgical processes. It reduces the flow of bile from the gallbladder to the intestines. It will then cause a sudden increase of bilirubin.
5. Other conditions and circumstances leading to the increase of bilirubin include inherited disease like Rotor’s syndrome, too much intake of alcohol, hepatic toxic drugs (drugs toxic to the liver), sickle cell anemia and septicaemia (blood poisoning). ^{(2, 5, 7)}

How to treat an increased level of bilirubin in urine?

There are various reasons why the level of bilirubin in the urine increases. Hence, the treatment and management for high bilirubin level primarily depends on the factors that cause it. If it is bacterial in origin, the doctor will prescribe antibiotics. An antiviral medication is used to treat high level of bilirubin of viral origin. If the patient has liver cirrhosis (an advanced liver disease), the best remedy is liver transplant. ⁽⁴⁾

If the cause of high bilirubin level is gallstone, the goal of the treatment is to dissolve the stone. If the stone is small, it can be dissolved using certain types of drugs. However, if the stone is quite big, the best approach is lithotripsy. It is a process in which the stone is destroyed via a series of ultrasound treatment. No incision is made.

Lifestyle change is highly recommended in patients with increased level of bilirubin. You should avoid drugs toxic to the liver. Consumption of alcohol should be restricted too. ^{(5, 10)}

Natural remedies for high bilirubin

• Reishi Mushroom – It is tested and proven effective in treating hepatitis. It prevents severe forms of liver disease. What this mushroom does is it stabilizes your immune system and improves the functions of the liber.
• Lemon – It is effective in stopping the liver from producing cholesterol. Lemon juice contains pectin, which is effective in alleviating gallbladder pain. Lemon has anti-inflammatory property, which aids in the treatment of jaundice. It has the ability to unblock bile ducts making it highly effective in controlling the level of bilirubin. ^{(2, 4)}
• Tomato juice – Tomatoes contain lycopene, which reduces injury to the liver. ⁽⁶⁾

References:

1. https://medlineplus.gov
2. www.healthline.com
3. https://labtestsonline.org
4. www.mayoclinic.org
5. www.medicalnewstoday.com
6. www.nytimes.com
7. www.webmd.com
8. www.medicalhealthtests.com
9. www.quora.com
10. https://en.wikipedia.org