To begin with, what precisely is bilirubin? It is the byproduct of red blood cells particularly hemoglobin. When it is no longer beneficial to the body or the cells will become destroyed, either the liver or spleen will be responsible for the breaking down of portions of the hemoglobin present in red blood cells. Indirect or unconjugated bilirubin indicates that the heme portion of the hemoglobin is broken down by the spleen. This is not soluble in water which means that it will not be dissolved. Then, it is brought to the liver to become another blood product referred to as albumin. It may undergo additional processing in order for it to be dissolved in water. Direct or conjugated bilirubin indicates that the heme is directly processed in the liver. It also means that it can be dissolved in water.
Yet, how will bilirubin be present in the urine and what does this indicate? Bilirubin which is conjugated or dissolved in water may be passed in the urine. Otherwise, bilirubin will circulate on the body through the red blood cells. The bilirubin is expelled as a component of bile. It is also responsible for the color of the feces and urine through additional processing done in the small intestine to a certain component termed as urobilinogen. This urobilinogen is transported back to the liver and will circulate into the blood before it is excreted from the body in the urine. The one which stays to circulate in the blood before its final removal will give rise to the coloring of bruises as well as yellowing of the skin and eyes which are observed in people with jaundice. Since bilirubin is a product itself, it is not usually present in the urine since it will be converted to urobilinogen. But trace amounts are common yet, there is nothing to worry about it.
Some Diseases and Conditions that can Increase the Bilirubin Levels in the Urine
The official medical term to denote elevated bilirubin levels in the urine is bilirubinuria. In general, bilirubin in urine is associated with problems that occur in the liver or gallbladder both in inflammatory or obstructive which can be cancerous processes. In some people, conditions which are inherited can also result to higher than normal levels of bilirubin in the urine.
Some Inherited Conditions in which Bilirubin is present in the Urine
• Dubin-Johnson Syndrome. This is an uncommon inherited condition in which the liver is prevented from conjugating bilirubin. As a result, one of the symptoms will be discernible levels of bilirubin in the urine. Usually, this condition can be diagnosed during infancy as the primary symptom of jaundice.
• Rotor’s syndrome. This is similar to Dubin-Johnson syndrome but is known to be more uncommon. This is also referred to as Florentin and Manahan Syndrome. Though, it has marked bilirubin levels in the urine yet this is somewhat different in terms of pigmentation of liver cells and also in the minute chemical components of bilirubin.
Hepatitis because of Bilirubin in the urine
Inflammation of the liver or hepatitis can produce visible levels of bilirubin in the urine resulting to cirrhosis of the liver. This can have some origins which include:
• Viral types of hepatitis such as B, C, A, E and D, parasites and bacteria
• Inflammation of the liver due to an autoimmune disorder which originated outside the live or the bile duct system that include type 1 diabetes, Graves disease which is the primary reason for an overactive thyroid, rheumatoid arthritis which is an autoimmune disorder affecting the heart and also the joints, Sjogren’s syndrome which results to a certain kind of anemia as well as ulcerative colitis which causes inflammation and presence of ulcers in the large intestine and in the rectum.
• Drugs, alcohol and frequently medications that can induce toxic hepatitis