Bilirubin is a yellow pigment that forms during the breakdown of red blood cells, more precisely, when the non-protein portion of hemoglobin, heme, is destroyed. Its metabolism in the body affects a large number of organs and systems, therefore it is of great interest for doctors of all specialties.
In the blood, the level of bilirubin is investigated in the framework of biochemical analysis, in the urine its presence and amount is determined by the total analysis of this biological fluid.
If the concentration of bilirubin in the blood is elevated or impaired liver function, then a significant amount enters the urine. Therefore, the presence of this substance in the blood speaks of liver diseases (cirrhosis, liver failure) or blood diseases (malaria, anemia, hemolysis).
Types of bilirubin
The overall indicator consists of indirect and direct forms of bilirubin. They focus on it when interpreting test results, and determine whether bilirubin is elevated or not. If the total bilirubin is normal, then it is not necessary to investigate its direct and indirect fraction.
- Indirect bilirubin is formed by the breakdown of heme substances and is a toxic substance that does not dissolve in water but is well soluble in fats.
- Direct bilirubin is formed in the liver, where it interacts with glucuronic acid and it is highly soluble in water and, together with bile, is excreted from the body.
When is an analysis prescribed?
Urinalysis for detecting the level of bilirubin and other indicators prescribed during routine checkups. A simple test allows you to identify diseases of the liver and gallbladder.
The study of urine with determining the amount of the main bile pigment is carried out in case of suspicion of the following diseases:
- cirrhosis of the liver;
- toxic and viral hepatitis;
- suspected spread of metastasis;
- obstructive jaundice;
- traumatic liver damage;
- jaundice of newborns;
- rare hereditary pathologies;
- tumor process in the pancreatic head.
Bilirubin detected in urine - what does it mean?
In the urine of an adult, the content of bilirubin is extremely small and is not determined by standard research methods (biochemical analysis of urine, urinalysis). Therefore, it is believed that normal urinary bilirubin is absent.
Therefore, the presence of bilirubin in the urine is characteristic of the appearance of diseases that are accompanied by damage to liver cells, which leads to the ingress of large amounts of bilirubin in the blood.
The determination of bilirubin in the urine is of great informative value in the diagnosis of the above diseases. The application of the technique allows:
- conduct early diagnosis of hepatitis;
- carry out differential diagnostics of mechanical and hepatic jaundice (there is no bilirubin in the urine in case of bile outflow disturbance);
- reliably judge the functional state of the liver (bilirubin in the urine of 17 mmol / l indicates a serious liver damage).
In addition to diseases that cause the death of liver cells, the appearance of bilirubin in the urine leads to conditions in which there is an increased formation of bilirubin itself.
Bilirubin in the urine of a pregnant woman
During pregnancy, bilirubin in the urine may appear from the same causes as other people. Expectant mother is not protected from infection with hepatitis, toxic effects of drugs or the development of gallstone disease. The growing uterus and increased intra-abdominal pressure worsens the outflow of bile, which can lead in the later periods to the appearance of bilirubin in the urine test, as well as the development of jaundice and pruritus.
If the bilirubin in the urine is elevated, an in-depth examination is required to rule out serious liver pathologies that may cause abortion. What does increased bilirubin in the urine, the doctor can tell. Self-diagnosis and treatment are not always beneficial. Pregnant women are responsible for the lives of two, so medical care must be qualified.
Bilirubin in newborns
Elevated bilirubin is a normal condition in newborns, as the body adapts to the new environment. Hyperbilinubicia does not require treatment from them, since everything is normalizing itself. Babies of this age often have some degree of jaundice.
But for various reasons, sometimes with an increase in the unbound form of bilirubin, a child may develop nuclear jaundice, which requires intensive therapy.
Causes of elevated bilirubin in the urine
Why is urine bilirubin elevated, and what does it mean? Bilirubinuria is a symptom of impaired liver function. The reasons for the detection of bilirubin in the urine are varied:
- acute viral hepatitis (in 90% of cases A or B);
- drug hepatitis (overdose of antibiotics, steroids, etc.);
- chronic hepatitis (most often viral etiology);
- liver tumors;
- biliary cirrhosis;
- in late pregnancy, some women may develop cholestatic hepatitis;
- toxic hepatitis (poisoning with hepatotoxic poisons);
- alcoholic hepatitis (chronic alcoholism);
- infectious diseases accompanied by the defeat of hepatocytes: leptospirosis, mononucleosis, brucellosis, etc.
In all these cases, urinalysis shows only direct bilirubin, which the liver has failed to bring with the bile into the intestine, because sick, and the enzyme got into the blood and kidneys. A blood test for direct bilirubin is also above normal.
At the same time, there are disorders in which there is a surplus of indirect bilirubin in the body (with hemolytic anemia, for example), and then a blood test shows it, and urine analysis does not.
We found out that the main cause of bilirubin in the urine is liver disease and the flushing of enzymes in the blood. Therefore, the main symptom of bilirubinuria - jaundice, in which the skin, eyes and mucous membranes of the patient become yellow.
In addition, any liver disease characterized by heaviness in the right hypochondrium, bitter belching. Ill complain of frequent nausea. Changes and color of feces, they become almost white. But the urine is getting dark. Sometimes patients complain of liver colic or itching. If you find the symptoms described above, immediately pass an additional examination by a specialist.
Depending on the disease (the root causes of bilirubin in the urine), appropriate treatment is prescribed. In addition to drug therapy, diet is appropriate, and even necessary.
What to do?
The sooner the indicators return to normal, the lower the risk of intoxication. It is important to remove hemoglobin decomposition products as soon as possible, to achieve optimal flow rates if the blood is too viscous.
Self-treatment is prohibited: the selection of unsuitable herbs and drugs prevents the outflow of bile, disrupts the affected organs, provokes diarrhea or constipation. Uncontrolled intake of interferon for the treatment of chronic hepatitis is especially dangerous: potent compounds have a lot of side effects, it requires precise selection of the name and dose, depending on the patient's weight, type of disease.
- antiviral drugs for detection of hepatitis;
- cholagogue in the development of pathologies of the gallbladder;
- drugs that dissolve stones on a plant-based (urates);
- hepatoprotectors that support the liver;
- immunostimulating compositions;
- droppers with blood purifying compounds, glucose preparations;
- reducing the amount of salt per day, a sufficient amount of pure water to remove toxins;
- Quitting smoking and all types of alcohol;
- diet to reduce stress on weakened liver and biliary tract. Prohibited carbonated beverages, mushrooms, hot spices and seasonings, garlic, onions, chocolate, smoked meats. You should not eat fresh white bread, margarine, refractory fats, pastry, cakes, canned food.
"How to treat low bilirubin in the urine?" This question arises quite rarely, but if a decrease in the level of bile pigment is detected, then it is necessary to urgently examine not only a gastroenterologist, but also a hematologist (specialist in blood diseases) and a phthisiologist. Treatment is prescribed taking into account the diagnosis made after other tests and analyzes.
It is important to increase the hemoglobin level: as long as the red blood cells in the blood are too low, the level of bile pigment will never rise to optimal values.