Bilirubin in Urine: Causes and What does it Mean

Bilirubin is a yellowish or brownish pigment that forms when red blood cells (RBCs) break down in the body. When bilirubin forms, it will move into the liver through albumin, appears in bile, and store in the gallbladder.

If your liver is not healthy, there may be too much bilirubin (hyperbilirubinemia) in the blood, causing jaundice and appearing in the urine (bilirubinuria). However, a healthy liver tends to remove urine bilirubin from the body.

The first time you see your urine has turned dark yellow or brown, it can come as quite a shock. Although this hue shift could be problematic, it does not usually indicate a significant problem. So it’s essential to rule out the leading causes of dark urine. This article will discuss bilirubin in urine symptoms, its causes, and treatments.

Urine Bilirubin
Urine Bilirubin

What is Urine Bilirubin?

Urine Bilirubin is also known as Urine analysis, Conjugated bilirubin, Chemical urinalysis, Direct bilirubin, Serum bilirubin, and total bilirubin.

Urine bilirubin is a chemical found in the blood that turns yellowish when bilirubin is present in urine. Numerous illnesses, including gallstones and liver disease, can cause it.

Bilirubin in Urine: What Does It Mean?

Bilirubin usually becomes water-soluble when bound in the liver. Bilirubin in urine is generally insoluble in water, so the kidneys cannot filter it. This symptom usually indicates the possible presence of conjugated hyperbilirubinemia.

Does bilirubin in the urine always indicate liver problems?

No, bilirubin in the urine does not always indicate liver problems. A large number of people have small amounts of bilirubin in their urine without any significant health problems. The presence of bilirubin in the urine could mean that you have a liver problem and requires further testing. However, it is not a definitive test for liver disease.

Bilirubin in urine during pregnancy

Higher bilirubin levels during pregnancy usually indicate that a pregnant woman’s red blood cells are not working correctly. Gallbladder disease and Hepatitis may cause this condition. You should consult a doctor as soon as possible for a comprehensive examination.

Elevated levels of bilirubin in the baby’s urine

Babies are born with various forms of hemoglobin. After a baby is born, these hemoglobins break down rapidly, resulting in high bilirubin levels in the blood. Jaundice may also occur.

Usually, a baby’s body excretes bilirubin through excretion. However, because the infant’s liver is underdeveloped, it cannot completely filter out bilirubin. This can lead to increased levels of bilirubin in the urine.

Urine bilirubin Test

Urine bilirubin can be tested to determine how well red blood cells carry oxygen to tissues and organs or how well the kidneys filter them. This test may include both unconjugated and conjugated forms.

The urine bilirubin (Bilirubinuria) test examines bilirubin levels in the urine. This test checks the state of the liver and also measures the chemicals, substances, and cells in your urine through a standardized urine dipstick (urinalysis).

What are the symptoms of Bilirubin in Urine?

The symptoms of urine bilirubin are usually mild. When you have it,

  • You may notice that your urine is stronger than the normal yellow color.
  • Additionally, you may detect blood in your urine, which may result from gallstones or liver illness.
  • Your urine may also have a powerful ammonia smell.
  • You may observe a brownish tinge to your skin, nails, and hair.

If you ignore these early indications, you may see additional symptoms such as

Fever: you may have a high fever and feel hot. There is no one specific temperature that indicates the presence of bilirubin, but it is generally considered to be above 37°C (98°F).

Chills: Bilirubin is a natural byproduct of red blood cells and causes the body to produce chills when it reaches high levels in the body. Chills can also occur due to other conditions, such as kidney stones or a low-blood-volume disorder.

Sweating: you may sweat more than usual and feel warm in your hands and feet when you’re sick with Urine Bilirubin Disease.

Headache: It is one of the most prevalent urinary bilirubin symptoms. The headache is usually mild, but it may be severe.

Kidney Damage (Nephritis): This condition causes kidney inflammation, leading to pain and tenderness in the lower back and swelling in the ankles and feet. In rare cases, this condition can lead to kidney failure, which requires immediate attention from your doctor.

Leg Pain: The pain caused by urinary bilirubin can occur anywhere along your leg, but it is more common on your inner thigh or knee.

Joint pain: You may have joint pain and stiffness, especially if you have a liver problem.

Muscle aches: Muscle aches are more common in people with liver problems than those without them, but they can also be caused by other conditions such as rheumatoid arthritis or gout.

Belly Pains: Pain in the belly is not uncommon with liver failure. It may be either sharp or dull, stabbing or burning.

Stomach upset: Many people with liver failure have stomach upset that is quickly relieved with antacids or milk of magnesia (a type of baking soda). Other causes include gallstones and kidney stones, so you must contact a doctor if you experience these symptoms.

Bilirubin in Urine
Bilirubin in Urine Causes

10 Common Causes of Bilirubin in Urine

1. A kidney or urinary tract infection

Your kidneys filter waste products from your blood and produce urine that contains some amount of bilirubin. If there’s an infection in your urinary tract, however, it can cause an increased amount of bilirubin to be excreted in your urine.

2. Hepatic diseases such as Hepatitis

Hepatitis is a common cause of Bilirubin in Urine. The liver produces bilirubin; if your liver isn’t functioning correctly, you’ll have high bilirubin levels in your urine.

Hepatitis can be caused by bacterial, viral attacks, or autoimmune disorders such as rheumatoid arthritis, diabetes mellitus, and Grave’s disease.

Symptoms of liver disease include abdominal pain, anorexia or weight loss, fatigue, and jaundice (a yellowish discoloration of the skin and eyes).

3. Obstruction of the gallbladder or Bile duct narrowing

Stone in the gallbladder can cause the gallbladder to be obstructed. Some inflammatory diseases can reduce the flow of bile in the gallbladder. This condition can cause bilirubin in urine.

4. Renal Failure

In renal failure, there are changes in the kidneys that cause them not to excrete enough bilirubin from the body into the urine. This can result in a very high level of bilirubin in your urine and can lead to jaundice or yellowing of your skin and eyes.

Pancreatic disease: Additionally, pancreatic dysfunction might result in high bilirubin levels in the urine. This occurs when unhealthy pancreatic cells produce too much uric acid, increasing hepatic bilirubin production.

5. Vitamin B12 deficiency

Vitamin B12 deficiency is the most common cause of Urine Bilirubin in adults. This can happen through:

  • deficiency of intrinsic factors causes malabsorption and then poor conversion of vitamin B12 to its active form, cobalamin
  • leaky gut syndrome (also called intestinal permeability) allows the passage of undigested food particles into the bloodstream
  • malabsorption due to surgery or chronic disease (such as Crohn’s disease), which prevents absorption of vitamin B12 and other nutrients

6. Iron deficiency anemia

Adults’ urine bilirubin is most commonly caused by iron deficiency anemia. It occurs when insufficient iron in the body cannot be absorbed from food or supplements.

The body tries to compensate for this by producing more red blood cells, but this can lead to a build-up of hemoglobin in the blood. In addition, it causes the red blood cells to become damaged and excreted in the urine, along with other waste products such as urea and bilirubin.

7. Hemolytic anemia

Hemolytic anemia is caused by a deficiency in red blood cells (RBCs) due to an inherited disorder called thalassemia or intermedia.

When a person has hemolytic anemia, some red blood cells break down prematurely because a specific enzyme (hemolysis) is missing or not working correctly. This causes excess production of bilirubin as well as other pigments, such as melanin.

8. Celiac disease

Celiac disease is an autoimmune ailment in which gluten (a protein in wheat, barley, rye, and triticale) causes damage to the small intestine.

Gluten causes damage to the lining of the intestine and triggers a response from your immune system that destroys healthy gut tissue (called villi).

This disrupts nutrient absorption and leads to malnutrition, diarrhea, and fatigue. Gluten can also affect your liver function, leading to excess bilirubin production, which appears as a dark brown color in your urine, and other jaundice symptoms like fatigue and weakness.

9. Kidney failure

Kidney failure can also cause urine bilirubin levels to rise above the normal range. This happens because it takes longer for these substances to leave the body after excreting from the kidneys than when other body parts produce them.

10. Other medications

Another reason for increased bilirubin levels in urine could be a toxic reaction from medications or drugs you have been taking for other conditions. Certain medications can prevent or treat cancer, infections, and other diseases.

These include methotrexate and trimethoprim-sulfamethoxazole (TMP-SMX). TMP-SMX treats urinary tract infections in people with cystic fibrosis who have a mutation in their CFTR gene that prevents them from producing saltwater channels in their lungs.

Methotrexate is used to treat many types of cancer, including some forms of leukemia and lymphoma.

In addition, excessive alcohol consumption, sickle cell anemia, Ulcerative colitis, sepsis, genetic diseases such as Roto’s syndrome, and taking drugs toxic to the liver can also cause bilirubin in urine.

What are the treatments and prevention of bilirubin in urine?

If your doctor suspects that you have bilirubin in your urine, he will likely order a series of tests to confirm the diagnosis. These include:

1. Physical Examination

Physical examination is the first step in detecting any possible problem related to bilirubin in urine. The physician will perform a complete physical examination to rule out any underlying medical condition that could be causing the elevated level of bilirubin in the urine.

The physician will also listen to your heart and lungs, check your blood pressure, and measure your height and weight.

Blood bilirubin level: A blood test is carried out to determine the amount of bilirubin in the blood. The normal range is 0–1 mg/dL (0–3 mg/L).

Urine bilirubin level: Urine tests are often used to diagnose jaundice, especially when it is present only in one body system, such as the liver or urine. Once bilirubin in urine is confirmed, treatment will typically involve addressing the underlying cause. This may include:

2. Medications

Your doctor may prescribe some medications to relieve bilirubin from your urine. Some of the medicines that can be given to treat bilirubin in urine may include:

Diamox (acetazolamide): This is used to treat patients with jaundice with hemolytic anemia, a genetic disorder that causes red blood cells to break apart during cell division. It works by helping the body remove bilirubin from the blood and into the urine.

Fluconazole: This is used to treat patients with a fungal infection called aspergillosis caused by a fungus called Aspergillus fumigatus. It also helps prevent reinfection after treatment for this condition has been completed.

Vitamin C: This powerful antioxidant helps lower bilirubin levels through its ability to reduce inflammation, leading to less pigment in the body’s cells (i.e., less pigment in liver cells).

Drugs like hydroxyurea (HU) or daunorubicin (DAUNORUBICIN):These drugs can help destroy or shrink cancer cells.

3. Lifestyle changes

Lifestyle changes can help reduce your risk of developing jaundice, such as eating healthy foods, avoiding alcohol, getting enough sleep each night, and staying hydrated throughout each day.

These changes may also help reduce your risk of developing another health condition related to high bilirubin levels in your blood or urine (such as liver disease).

4. Surgery

Surgery may be necessary if there’s no other way to remove bilirubin from your body. You will be administered a general anesthetic during surgery to stay completely asleep.

In some cases, bilirubinuria may resolve on its own without treatment. The condition is usually diagnosed through elevated total serum bilirubin (TSB) levels, which a routine blood test can detect.

According to MedlinePlus, if these levels are high enough, then further testing may be required, such as

  • An ultrasound scan to check the liver and gallbladder
  • An abdominal CT scan to detect liver cancer, pancreatic cancer, and lymphoma, among others. It can also be used to detect gallstones and cysts in the gallbladder.
  • A percutaneous liver biopsy: This is a type of surgical procedure where a small needle is inserted into the skin over the belly button and then advanced through the abdominal wall into the liver; it allows doctors to remove a piece of tissue from the liver for examination under a microscope.

When should you see a doctor?

The first thing you would do is to check your blood levels of bilirubin. The normal range is 0-50 mg/dL. Anything higher than that means you are getting into dangerous territory, and it is time to see your doctor about it.

You can also use a home test kit for this purpose, but if you have any doubts or questions, you should go directly to the nearest hospital or clinic.

If you notice or observe any persistent symptoms of bilirubin in your urine or body, you must see a doctor immediately. If left untreated, bilirubin in urine can lead to jaundice, anemia, and other health complications.

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