All About Bilirubin in Urine

Tatiana Cromwell
Tatiana Cromwell
November 25, 2022
8
min read
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.

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

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.

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.

A diseased liver showing chirosis of the liver.

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.

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.

Liver diseases such as jaundice cause a characteristic yellowing of the skin and eyes.

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.  

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
Colors of the bilirubin reagent test pad when the test result is negative. Any shade of white or cream is considered a negative result.

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.

The reagent pad for bilirubin turns to peach, pink, or reddish-brown when bilirubin is present in the urine. The darker/deeper the shade, higher the concentration of bilirubin in the sample.

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

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.

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References
  1. Mayo Clinic, Bilirubin test, Accessed Nov 25, 2022.
  2. Health Encyclopedia, “Direct Bilirubin,” University of Rochester Medical Center.
  3. Fevery, J. (2008). “Bilirubin in clinical practice: a review,” Liver International, 28(5), 592–605.
  4. S. K., & Di Lorenzo, M. S. (2014). “Urinalysis and body fluids,” Strasinger, FA Davis, 85-87.
  5. Guerra Ruiz, A. et al. (2021). "Measurement and clinical usefulness of bilirubin in liver disease," Advances in Laboratory Medicine, 2(3), 352 361.
  6. American Liver Foundation, “Liver Disease Diets,”
  7. MedlinePlus, “Bilirubin in urine,” National Library of Medicine, NIH.
  8. Dr. Kyle Riding, “What Can Elevated Levels of Bilirubin Indicate?” Video Lecture, Diverse Health Hub.
About the Author
Tatiana Cromwell

Tatiana Cromwell is a highly experienced and skilled medical writer with a degree in psychology. With over 50 years of experience in the field, she has a deep understanding of medical terminology and the intricacies of the healthcare industry.

Throughout her career, Tatiana has worked with a range of clients, including pharmaceutical companies, hospitals, and medical device manufacturers, to produce high-quality content for a variety of purposes. She has a particular interest in mental health and has written extensively on topics such as anxiety, depression, and addiction.

In addition to her writing skills, Tatiana is also an excellent communicator and is highly adept at translating complex medical concepts into easy-to-understand language. This has made her a valuable asset to her clients and has helped her to build a strong reputation in the industry.

Outside of her work as a medical writer, Tatiana is a passionate advocate for mental health awareness and is dedicated to helping others access the support and resources they need to thrive. She is an active member of several professional organizations and is always looking for ways to improve her skills and knowledge in her field.

About the Reviewer
This blog was
Technically reviewed by: 
H. Ali, Ph.D.

Hussnain Ali received his Ph.D. degree in EE in 2015 from the University of Texas at Dallas, USA. He is the co-founder and the Chief Executive Officer (CEO) at Diagnox Health, Plano, TX 75024, USA, and a visiting research scientist at the University of Texas at Dallas. His academic and industry experience spans over 15 years in organizations like the Center for Advanced Research in Engineering, The University of Texas at Dallas, and Harman/Samsung. He has served as a co-PI on an RO1 grant from the National Institutes of Health (NIH). His research interests include biomedical devices, auditory rehabilitation, and cochlear implants. He has authored and co-authored over 70 international publications and has been awarded multiple US patents. His latest work at Diagnox encompasses the development of innovative healthcare and wellness products/solutions that provide convenient and affordable at-home screening/diagnosis. He aims to bridge conventional clinical diagnostic products with Artificial Intelligence (AI) and contemporary data-centric technologies to modernize the healthcare and wellness industry.

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