What Does It Mean If You Have Urobilinogen in Your Urine?

Medically Reviewed on 1/30/2023

Illustration of the human liver
Causes of excess urobilinogen in urine may include viral hepatitis, cirrhosis, or liver damage.

Excess urobilinogen in urine may indicate liver diseases, such as viral hepatitis, cirrhosis, or liver damage.

  • It is caused by drugs, toxic substances, or conditions associated with increased red blood cell destruction (hemolytic anemia).
  • In a person with low urine urobilinogen and/or signs of liver dysfunction, it can be indicative of hepatic or biliary obstruction.

Urobilinogen is a substance that is produced when bilirubin, a waste product produced by the breakdown of red blood cells, is processed in the liver and released into the intestine.

  • Some of the urobilinogen produced in the intestine is reabsorbed and returned to the liver; the rest is excreted in the feces.
  • A small amount of urobilinogen is excreted in the urine.

What are the ranges of urobilinogen in urine?

The normal range of urobilinogen is less than 17 umol/L or 1 mg/dL. It is common to have values within the 0 to 8 mg/dL range. An increase or decrease in urobilinogen is considered abnormal and is investigated in a clinical setting.

When do doctors order urobilinogen tests?

Urobilinogen urine tests could be ordered at your regular checkup, as part of ongoing liver condition monitoring or if you have symptoms of liver disease. They include

Urobilinogen levels in urine that are higher than normal may indicate

Having urobilinogen in your urine does not necessarily mean that you have a serious health problem. However, if you have elevated levels of urobilinogen in your urine, talk to your doctor about it and discuss any potential underlying causes. Your doctor may recommend further testing or treatment, depending on the underlying cause of the urobilinogen in your urine.

What does it mean when urobilinogen is low or negative?

A low or negative result for urobilinogen on a urine test may indicate

  • A problem with the liver or the bile ducts, which can affect the body's ability to produce and excrete bilirubin
  • A problem with the production or breakdown of red blood cells

Urobilinogen level in urine could be low or absent due to

  • Blockage in the structures that carry bile from your liver
  • Blockage in the blood flow of the liver
  • Problem with liver function
  • A low or negative result for urobilinogen on a urine test is not always a cause for concern. It can be due to diet, medications and other medical conditions. Discuss the results of a urine test with a doctor to determine the cause and any necessary treatment.

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What causes urobilinogen in urine?

A small amount of urobilinogen is naturally found in the urine. A level below 1 mg/dL is not considered clinically significant. However, when combined with other abnormalities in urine and bloodwork, higher levels may indicate a health problem.

Liver disease

  • Liver cirrhosis, hepatitis, or liver cancer can increase bilirubin and urobilinogen levels in the urine. Symptoms of liver disease may not be apparent until urobilinogen levels become apparent.
  • When urobilinogen levels are high in the urine, the doctor may order complete blood counts and liver enzyme tests.

Blood cell abnormalities

  • Several conditions cause the body to produce antibodies that destroy red blood cells. The result will be an increase in bilirubin levels in the blood, which can be detected through a blood test or a high level of urobilinogen in the urine.

Biliary disease

  • Cholestasis (obstruction of the bile ducts) or cholangitis (inflammation of the bile ducts) may cause urobilinogen levels to increase in the urine, as well as an increase in bilirubin and liver enzyme levels.

Congestive heart failure

  • The heart does not pump as much blood as is needed to ensure adequate perfusion. As a result, sufficient oxygen and nutrients do not reach the organs and tissues. In response to the heart's decreased ability to pump blood, the kidneys attempt to compensate by retaining fluid in the body. As a result, the arms, legs, ankles, and other organs will swell and appear congested.

Lead poisoning

  • The most common cause is the ingestion of lead-based paint or dust contaminated with lead in older buildings. Other sources of lead poisoning are contaminated air, water and soil. When lead builds up in the body over time, it causes health problems and severe liver damage.

Certain medications

  • Antibiotics can destroy beneficial bacteria in the gut that convert bilirubin into urobilinogen. Vitamin C and ammonium chloride may increase the acidity of the urine when taken in large amounts. Acid urine will have a lower concentration of urobilinogen.

How is excess urobilinogen in urine treated?

Excess urobilinogen in urine or urobilinuria can be caused by several factors, including liver disease, certain medications and gastrointestinal problems. The treatment for urobilinuria will depend on the underlying cause.

  • If urobilinuria is caused by liver disease, the treatment will focus on addressing the liver problem. This may involve medications, such as antiviral medications for hepatitis or medications to reduce inflammation in the liver. In some cases, a liver transplant could be necessary.
  • If urobilinuria is caused by certain medications, switching to a different medication or adjusting the dosage could be necessary.
  • If urobilinuria is caused by gastrointestinal problems, such as inflammatory bowel disease or a blockage in the intestines, treatment will focus on addressing these issues. This may involve medications, dietary changes or surgery.

Doctors may identify and treat the underlying cause of urobilinuria to effectively manage the condition.

Medically Reviewed on 1/30/2023
References
Analysis of urobilinogen and urine bilirubin for intra-abdominal injury in blunt trauma patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691510/

Bilirubin – urine. https://www.mountsinai.org/health-library/tests/bilirubin-urine

Failure of prediction of liver function test abnormalities with the urine urobilinogen and urine bilirubin assays. https://pubmed.ncbi.nlm.nih.gov/2642693/

Use of the Urobilinogen Test for the Detection of Para-Aminosalicylic Acid in the Urine. https://www.nejm.org/doi/10.1056/NEJM195910292611807?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed