Urobilinogen is formed as a result of the metabolism of bilirubin and appears as a bile pigment. This substance gives urine its characteristic color. And if the presence of bilirubin directly in the urine is regarded by doctors as a pathology (bilirubinuria), then the presence of this substance indicates something else. If urobilinogen is detected in urine, what does this mean? This question interests many patients. Its moderate content in urine is a variant of the norm. Well, if the norm is exceeded or underestimated, how to assess this? Let's look at it in more detail.

Bile pigments

An important indicator when taking urine tests is bile pigments. An increased amount of urobilinogen in the analysis may indicate the cause of certain diseases of the body. This substance is formed as a result of the breakdown of hemoglobin, as well as other proteins in the body that contain it. This pigment is found in bile, which gives it its yellow color.

Among the analysis indicators, the most valuable is bilirubin, as well as the products of its transformation; they, in turn, are formed in the intestines under the influence of microflora (bilirubinoids). To detect them, urine is checked very carefully. Urobilinogen also plays an important role. The doctor must consider its significance, and if urobilinogen is detected in the urine, what this means must be explained to the patient. If necessary, send for further examination.

Urobilinoids

Any healthy person has a certain amount of urobilinogens in their urine. After oxidation in urine, they are converted into urobilins. In order for urobilinogen to completely transform into urobilin, urine must stand in the light for at least a day. For this reason, the determination of urobilinogen in urine is carried out using fresh tests.

To determine the amount of urobilin, standing urine is examined. It has a yellowish tint, whereas urobilinogen has no color in urine. This explains the fact why, after standing in the light, urine darkens. These substances (urobilinoids) are derivatives of bilirubin, which, in turn, is excreted in bile. In my own way chemical composition urobilinoids have a similar structure. If bilirubin has not reached the intestines, then these substances are not detected. This happens for a number of reasons: hepatitis, blockage of the bile ducts, fistulas.

How are they formed?

Urobilinogen is formed from red blood cells (up to 80%), to be more precise, from bilirubin, which, in turn, is synthesized from hemoglobin. At its core, urobilinogen is nothing more than a product of red blood cell utilization. How does the process work? Having served due date, hemoglobin molecules must be utilized. First, indirect bilirubin is synthesized from them, and it enters the intestines with the flow of bile. Under the influence of microflora, bilirubin undergoes further transformations. Multiple complex biochemical reactions help form a series of intermediate substances. Some of them (mesobilinogen, stercobilinogen) are reabsorbed into the blood, and some are excreted in the feces. The part that enters the blood is recaptured by liver cells. Urobilinogen is again excreted with bilirubin in bile. A small part of the blood passes past the liver through hemorrhoidal anastomoses. Thus, part of the urobilinogen enters the urine. For various reasons, its quantity may be different. If urobilinogen is present in the urine, what does this mean, we will consider further.

Norm

In a healthy person, the urine of urobilinogen contains a tiny amount, so when it is determined, tests show a negative result. From here it is clear that the numbers do not indicate urobilinogen in the urine (the normal reading is 5-10 mg/l), but simply put the result “+” in the value. A weakly positive reaction is “+”, “++” is positive and “+++” is strongly positive. Some conditions affect these indicators. If urobilinogen levels are elevated, a diagnosis of Urobilinuria is made.

When analyzing urine, it is very important to determine the level of urobilin. Based on these readings, the doctor can judge how the urinary system works. The normal color of urine is slightly yellowish and transparent. If dehydration occurs in the body, the amount of water in the urine decreases sharply, and urobilinogen becomes more concentrated. As a result, the urine becomes darker. Also, its color can be influenced by certain medicines, various diets, alkoptonuria (hereditary disease).

Increased performance. What do they mean?

As we found out, normally the urobilinogen level is negative - its amount in the urine is so insignificant. In what pathologies can the level of this indicator in the blood increase, in which case does urobilinuria occur? First of all, urobilinogen in the urine is increased in chronic, acute liver pathologies; in those conditions when red blood cells are destroyed, the intestines do not function normally. Namely when:

  • cirrhosis, hepatitis of the liver;
  • malignant or benign tumor;
  • congestion in the liver;
  • hemolytic anemia, in this condition there is a complete breakdown of erythrocytes (red blood cells);
  • poisoning chemicals, when the breakdown of red blood cells also occurs, hemoglobin in this case appears freely in the blood plasma; this, in turn, increases the formation of bilirubin, and it is excreted in bile (as we have already found out, urobilinogen is formed from bilirubin).

The following factors also influence the increase in the indicator:

An increase in urobilin, as many doctors say, is not an obvious pathology, but only indicates the possibility of its presence. So, in some conditions, when excess waste is released into the intestines (for example, with diarrhea), the kidneys receive additional stress, as a result - the presence of urobilinogen in the urine. This only confirms that the kidneys are doing their job.

Reasons for the increase

Let's summarize. What does urobilinogen show in urine? Either excess production of bilirubin by the liver, or slow utilization of it. Such symptoms appear in liver diseases (cirrhosis, hepatitis) or in hemolysis (the process of destruction of red blood cells).

What other reasons for the increase exist:

  • severe pathological changes in the spleen;
  • poisoning with poisons, toxins;
  • blood transfusion of inappropriate group, Rh factor;
  • alcoholic liver damage;
  • liver failure as a consequence of myocardial infarction;
  • enterocolitis, ileitis;
  • thrombosis, hepatic vein obstruction;
  • insufficient fluid intake, excessive excretion.

Urobilinogen in urine during pregnancy

This pigment becomes highly concentrated when liver function is impaired. This may be caused by a hereditary predisposition or diseases such as cholestasis, hepatitis. If a pregnant woman has increased urobilinogen in her urine, it darkens and takes on the color of dark beer.

Another reason for the increase in the concentration of urobilinogen in the urine may be toxicosis, which contributes to increased fluid loss. In this case, the indicator fluctuates between 20 - 35 µmol/l.

Many pregnant women, upon receiving the test result, are interested in what such a high indicator means. Only an obstetrician-gynecologist can give such advice at an appointment, and perhaps send you for additional examinations.

After carrying out diagnostic measures, the doctor will make a conclusion about whether elevated values ​​indicate toxic damage to the body or the development of blood pathology.

If you are sure that darkening of urine is in no way connected with fluid deficiency, increased fluid losses, or the use of any medications, then be sure to consult a specialist; dark urine is an alarming signal.

Urobilinogen in the urine of a child

Daily concentration of urobilinogen in urine infant should not exceed 2 mg/l. If this figure is exceeded, the following diseases are suspected:

  • hepatitis;
  • cholelithiasis;
  • cirrhotic liver damage;
  • severe colitis;
  • other infections.

To find out the true cause, you should familiarize yourself with the characteristics of the infant’s developmental period. In infancy, the body mainly adapts to the surrounding world, the external environment. Jaundice is characteristic of newborns; it is caused by the breakdown of fetal hemoglobin (hereinafter referred to as red blood cells). As a consequence, it is formed increased amount urobilinogen, which is found in urine. The phenomenon of jaundice at this age is temporary, so increased urobilinogen in the urine is the norm for newborns.

Reduced urobilinogen

What if urobilinogen is not present in the urine? What does this mean? Doctors do not consider the absence of urinobilinogen in the urine as a valuable indicator, but this cannot be classified as normal. If this substance is completely absent in the urine, but bilirubin is detected, this may indicate blocked bile ducts or subhepatic jaundice. This is also a characteristic symptom of hepatitis A.

If bile does not enter the intestinal lumen, this also causes a decrease in urobilinogen in urine. The pigment concentration may also decrease in large volumes of urine in cases where fluid intake is exceeded (with some fruits).

What should I do?

Urobilinogen found in urine - what does this mean? What should be done in this case? The first piece of advice is don't panic. Nervous stress and negative emotions cause the manifestation of stagnation in the body. If urobilinogen levels are elevated, you should definitely consult a doctor to find out the true reasons, you need to undergo additional examination.

Often those people who work at night and do not sleep have their biological clock disrupted. In this case, the reaction to the presence of urobilin bodies can be positive. In such a situation, restoring the regime can bring the body back to normal.

Active lifestyle, physical activity, water treatments Help the body get rid of toxins in a timely manner. A dairy-vegetable diet is also useful in such cases, as it will improve intestinal function. In this case, medicinal bitter herbs will not interfere: wormwood, immortelle, elecampane, tansy, milk thistle. They will restore the body and help remove excess toxins from the intestines. The infusion is prepared as follows: pour one tablespoon into 0.5 liters of boiling water and leave for half an hour. Take ¼ glass before meals.

Even a person who has no health complaints should undergo periodic tests to eliminate the risk of developing various diseases and the formation of pathologies. One of the main tests is to check the urine for the presence of certain types of organic substances. If you promptly diagnose bile pigments in the urine, you can prevent the development of dangerous diseases and eliminate the inflammation that has begun.

Urine changes depending on various factors of the external and internal environments. The appearance and composition of urine can change due to the development of diseases and even the food eaten.

The following must be present in the urine:

  • water;
  • electrolytes;
  • organics.

Urine is a product that is formed as a result of metabolic processes in the kidneys and the filtration of blood in them.

By doing a urine analysis, you can determine:

  1. How correctly and well the kidneys work.
  2. How do metabolic processes occur in the body?
  3. Are there pathological changes that can lead to various diseases.

If a urine test is done during the treatment of existing diseases, the results can be used to draw a conclusion about positive or negative changes in health. One of the main indicators of the analysis is the presence and level of bile pigments.

There may be 2 types of them in urine:

  • bilirubin;
  • urobilinogen.

Both substances are produced by the division of red blood cells. When unbound bilirubin enters the blood cells, the cells begin to break down and react with a substance such as glucuronic acid as they pass through the liver. As a result, a bound pigment begins to form, entering first the bile and then the intestines.

When the intestinal microflora reacts with enzymes, urobilinogen is formed, which is partially absorbed by the blood and then released along with urine.

If a person has had their gallbladder removed or has various pathologies and diseases of the biliary system, the following are diagnosed:

  1. Bilirubinuria.
  2. Urobilinogenelia.

In the absence of pathologies and various diseases, bilirubin should not be present in the urine test. But the urobilinogen level can change throughout the day.

Bilirubin is formed by liver cells after the breakdown of red blood cells, which provoke an increase in hemoglobin.

The pigment can be of 2 forms:

  1. Unconjugated or free. May be elevated. However, the pigment does not pass beyond the renal membrane. Accordingly, this form of bilirubin is absent in urine.
  2. Conjugated or bound bilirubin. It actively interacts with glucuronic acid, transforming into a soluble substance. It easily penetrates into the liver secretions, urine, and intestines.

Urobilinogen is formed after bilirubin enters the intestines.

Here the pigment is modified:

  • mucosal enzymes;
  • bacteria.

As a result of the presence of urobilinogen, stool becomes colored light color, and urine - in the dark.

Bile pigments in urine such as bilirubin and urobilinogen first enter the liver, after which they are sent to the gallbladder and intestines. In a healthy person, the compounds are absorbed into the blood and are not detected in urine.

Normal indicators are:

  • lack of bilirubin;
  • 5-10 mg/l urobilinogen.

The urobilinogen level is negligible. The complete absence of bilirubin indicates a normal state of health. This means that the liver and other biliary organs are functioning correctly and fully.

If the pigment bilirubin is still detected in the urine, additional tests and studies must be prescribed.

In this case, the following become mandatory:

  1. General blood test.
  2. Ultrasound examination liver and gall bladder.

Determination of bile pigments in urine in children occurs somewhat differently. Let's assume an increased level of urobilinogen, since the formation of intestinal microflora occurs before the age of 3.

Bile pigments may be present in human urine due to the following reasons:

  1. The appearance of stones that began to form in the kidneys and urinary tract.
  2. The development of blood diseases in which red blood cells are quickly destroyed. This happens, for example, with malaria.
  3. The presence of bleeding in various internal systems and organs. Most often this occurs in the gastrointestinal tract, uterus and lungs.
  4. Hemorrhagic diathesis.
  5. Congestion in the rectal area.
  6. Infections enter the gallbladder, as well as the ducts of the organ.
  7. Progression of liver diseases. Among them are cirrhosis and various types hepatitis.

In addition, deviations from the norm of bile pigments can be caused by poor nutrition, in particular, abuse of saturated carbohydrates. In a healthy person, the level of urobilinogen ranges from 5 to 10 mg/l.

A decrease in the indicator may occur for the following reasons:

  • blockage of the bile ducts;
  • liver dysfunction, which occurs due to the development of hepatitis A;
  • excessive fluid intake;
  • imbalance of bacterial flora;
  • lack of the enzyme glucuronyl transferase.

Due to these factors, the following pathologies and diseases may develop:

  1. Stones in the gallbladder or its ducts.
  2. Tumors of bile-forming organs.
  3. Cholangitis.
  4. Suprahepatic jaundice.
  5. Various poisonings and intoxications.
  6. Hepatitis.
  7. Cirrhosis.
  8. Filatov's disease.
  9. Enteritis.
  10. Constipation.

If there are no urobilinogen compounds in the urine, this means that the patient suffers from a severe form of hepatitis, which is viral in nature. The second cause of deviations is toxic damage to liver tissue.

When bilirubin enters the urine, it takes on an unusual color. It is dark brown. If you notice changes in your urine, you need to consult a doctor and get tested. This will help determine why there is bile in the urine.

Often urine dark color observed in people who have had their gallbladder removed. In addition, changes in the color of urine can be a prerequisite for the development of bilirubinuria.

Bilirubin does not dissolve in water. Therefore, the pigment is present in urine pure. The bound compound of hepatic glucuronic acid enters the urine. If the level of this bile pigment begins to increase in the blood, the excess is excreted through the kidneys into the urine. This usually occurs due to progressive diseases of the liver and bile ducts.

Pathologies of the liver and biliary tract can lead to the formation of congestion. Immobilized bile promotes the active formation of cholesterol and bilirubin. They precipitate and crystallize. The process is accompanied by the fouling of cholesterol and pigment particles with calcium salts. This becomes the main reason for the formation of stones.

The presence of bilirubin in the blood and its absence in urine analysis indicates hemolytic jaundice. The kidneys were unable to properly filter the pigment, so it could not pass into the urine.

The main reasons that lead to the development of bilirubinuria are:

  1. Formation of stones in the kidneys and urinary tract.
  2. Unhealthy diet, which is dominated by foods enriched with carbohydrates.
  3. Blood diseases that lead to its rapid destruction.

If any deviations are found, you should seek advice. This will help to diagnose a developed disease in a timely manner and avoid the development of complications.

The color, consistency, and even smell of urine can indicate the presence of certain health problems. Therefore, you should be attentive to the appearance of unusual signs and immediately consult a doctor. If bile pigments are detected in the urine, the doctor will explain what this all means.

A change in the amount of pigments in urine indicates disturbances in the dissolution of bilirubin, as well as the filtration of urobilinogen. Usually failures occur after removal of the gallbladder or as a result of the development of liver disease. In addition, violations may indicate that the process of removing stones from the biliary system was carried out incorrectly.

Therefore, a urine test for the presence of bile pigments is prescribed for the following patient complaints:

  • presence of dyspeptic disorders;
  • the appearance of unclear pain from the right hypochondrium;
  • skin and the mucous membranes acquire a yellow tint;
  • urine becomes dark in color and stool becomes light.

The doctor must make sure that the patient has not been exposed to toxic poisoning, for example, from drugs. Under their influence, the kidneys and liver fail faster than other organs. Conducting a urine test for the presence of bile pigments will help the doctor draw a conclusion about the degree of the disorder and prescribe correct treatment.

It is important to carry out the most accurate and correct diagnostic measures in order to refute or confirm the pathology. To do this, you need to examine your urine for the presence of pigments. The analysis will help identify substances contained in the urine.

Bilirubin can be detected by oxidation of the starting material with iodine or nitric acid. If a pigment substance is present, the urine turns green during the reaction. For analysis, you need to take a sterile test tube and add 5 milliliters of urine. Then the solution containing iodine is added layer by layer.

As the last one take:

  • Lugol;
  • potassium iodide;
  • alcohol tincture.

To check urobilin levels, you need to remove bilirubin from the urine. The pigment will interfere with the reaction carried out with a solution of calcium chloride and ammonia.

After eliminating bilirubin, you can begin various tests:

  1. Copper sulfate. It is combined with urine by adding a chloroform solution. The “cocktail” is shaken. The solution should turn intense pink.
  2. Spectroscope. The decoding will show the remainder of the blue-green part of the spectrum.

The color intensity of the solution during testing is marked with crosses. One will mean a weakly positive reaction, and 4 plus signs will mean a strongly positive reaction.

Determination of the level of bile pigments can only be carried out in special laboratories and clinics where biochemical reagents are available.

Rules for collecting urine for analysis

The result of a urine test is influenced by the correct collection required material. If the rules are not followed, the result may be inaccurate. Accordingly, the prescribed therapy will also be incorrect.

When collecting urine, it is important to follow several rules.

Among them:

  1. The night before collecting material for analysis, it is necessary to perform a thorough external toilet of the genital organs.
  2. Collect urine in a special container in the morning. The container may not be sterile, but it must be clean.
  3. Remove the collected material to a dark place. Bile pigments are destroyed by light. Therefore, if it is not possible to immediately submit urine to a laboratory, it is better to put the material in the refrigerator. Here urine can be stored for no more than 2 hours.
  4. It is enough to collect 30-50 milliliters for research.

It is important to promptly detect the presence of bile pigments. Any violations or deviations from the norm can cause the development of serious diseases and complications.

How long should I wait for the analysis result and what is its cost?

Urine testing for the presence of bile pigments is carried out within one working day. The cost of analysis in many clinics ranges from 150 rubles. If you are served under a policy, the insurance company pays the fee. The analysis is free for the patient.

Bile pigments in urine make it possible to assess the functional capacity of the gastrointestinal tract and identify initial signs of organ dysfunction. In a healthy person, the saturation of urine with urobilinogen does not exceed 17 mmol/l, and there is no bilirubin. Changes in the concentration of substances indicate disorders of various origins. By the nature of the increase and the ratio of substances, the doctor can tell at what level the failure occurred.

What do bile pigments in urine mean?

Bile pigments. Substances are capable of coloring the discharge in the appropriate color.

Normally, bilirubin in the urine is practically absent and is not detected by standard tests. The appearance of this fraction indicates bilirubinuria and the initial manifestations of hepatobiliary dysfunction: hepatitis, cirrhosis, liver tumor. In such cases, patients' urine darkens and acquires the characteristic black-brown color of beer.

Urobilinogen - bilirubin transformed in the intestines, penetrates the kidneys and is excreted in the urine. The concentration of the substance is small, providing a straw-yellow color. Substance is constantly present in bladder, indicates the normal functioning of the gastrointestinal tract and excretory system. After oxidation in air, it turns into urobilin and acquires a darker yellow color.

A significant increase in urobilin appears with an increase in blood bilirubin fractions, impaired reabsorption of breakdown products, and a block in the intestines. A negative test for urobilin indicates a lack of bile outflow from the liver or severe damage to hepatocytes. An increase and decrease in bile pigment fractions are unfavorable signs of emerging disorders.

Species

The following urine pigments are known: bilirubin and urobilin. After heme is broken down, an unbound fraction of bilirubin circulates in the blood. This product is insoluble in liquid media and does not pass through the kidney filter into the urine. The substance is extremely toxic and needs to be neutralized. After entering the liver, the substrate is transformed: it combines with glucuronic acid, becomes hydrophilic, and low-hazard. The pigment then travels through the bile ducts into the small intestine. A small portion of bilirubin is reabsorbed by the portal vein system, and the remainder is excreted in the feces as stercobilin. A portion of the conjugated substance enters the urine in the form of urobilinogen, where it is oxidized and becomes urobilin.

Reasons for appearance

In the normal state, bile in the urine is contained in minimal concentrations, which can fluctuate throughout the day, but do not exceed permissible limits. Normally, only urobilin is excreted in urine. The appearance of bound soluble bilirubin indicates pathology. At the same time, the substance itself is always elevated in the blood; the value of the indirect fraction may vary.

The absence of urobilin occurs with inflammation, tumor blockage of the bile ducts, impaired urination, and terminal liver lesions.

Video: All about bilirubin

In adults

In practice, doctors more often encounter disturbances in the excretion of heme breakdown products in the working population. Reasons that cause the appearance of bilirubin in urine:

  • GSD, cholestasis;
  • infections;
  • intoxication, poisoning;
  • hepatitis, Botkin's disease;
  • cirrhosis;
  • tumors of the hepatobiliary tract;
  • removed gallbladder;
  • intestinal obstruction;
  • disorders of the heart and blood vessels leading to hypoxia of the parenchyma;
  • hypothyroidism

Urobilin increases under the following conditions:

  1. Diseases of the liver parenchyma, when reuptake of bilirubin does not occur and high concentrations of pigments remain in the blood, exceed the renal filter and are found in the urine.
  2. Increased hemolysis of red blood cells. In addition to the physiological increase during menstruation and the neonatal period, it occurs with malaria, pneumonia, bleeding of various locations, disorders of the coagulation system, and sepsis.
  3. Gastrointestinal pathologies with increased absorption of hemoglobin breakdown products: chronic constipation, intestinal obstruction.

In children

Often. The phenomenon is associated with physiological adaptation: the replacement of fetal hemoglobin is accompanied by an increase in the breakdown of red blood cells, and newborn jaundice occurs. It is important to monitor the dynamics of the condition: a rapid increase in the concentration and appearance of bilirubin in urine indicates a disruption of the natural process and the appearance of pathology.

IN early age The reasons for the appearance of pigments in urine are:

  • genetic damage to the enzymatic transformation of bilirubin - Rotor, Crigler, Dubin-Johnson syndrome;
  • disorders of the blood system (hemorrhagic diathesis, Werlhof's disease);
  • hemolytic jaundice;
  • intussusception followed by intestinal obstruction.

During pregnancy


At the time of gestation, the load on all organs and systems increases. Even in healthy women, an increase in urobilinogen can be detected in the urine. In this case, patients complain of darkening of the urine. In cases where there is pathology of the biliary system before pregnancy, the condition may worsen. Additionally, increased work of the heart and kidneys plays a role, contributing to an increase in the volume of blood volume and the concentration of absorbed substances.

Monitoring the level of bile pigments allows you to indicate the onset of an exacerbation. The patient in interesting position it is necessary to exclude cholecystitis, viral hepatitis, pyelonephritis, and coagulation system disorders.

Diagnostics

Isolated slight darkening of urine is usually not a cause for concern. However, if you notice the following signs, you should consult a specialist:

  • dark brown urine;
  • discolored stool;
  • fever, weakness;
  • dyspeptic disorders (nausea, vomiting, stool disorders)
  • skin itching;
  • urinary disturbance;
  • icterus of the skin, mucous membranes;
  • pain in the right hypochondrium;
  • the appearance of spontaneous hematomas.

First of all, you need to visit a therapist to prescribe standard urine tests to detect bile pigments. If violations are detected, the doctor determines the probable cause of the condition. With this in mind, it becomes clear which specialist to turn to for help. Blood diseases are corrected by a hematologist. Hepatitis is treated by an infectious disease specialist. Hepatobiliary tract disorders – gastroenterologist, surgeon if necessary.

For diagnosis the following is prescribed:

  1. Complete blood count to determine anemia due to increased breakdown of red blood cells.
  2. Blood biochemistry allows you to determine the concentration of fractions of bilirubin, alkaline phosphatase, protein, and get an idea of ​​​​the functioning of the liver.
  3. Hemotest - analysis of stool for hidden blood if gastrointestinal bleeding is suspected.
  4. Determination of markers of viral hepatitis during blood sampling.
  5. Ultrasound of the abdominal organs.

The main way to identify pigments is a qualitative study of various environments of the body (urine, blood, feces). Special tests are carried out for the presence of urobilinogen: Florence, Gmelin, Rozin, Bogomolov. For reactions, iodine, nitric and hydrochloric acids are used, which combine with the components of bile to form a specific color. Depending on the intensity of the resulting shade, the laboratory technician in conclusion indicates the type of reaction: from weak (+) to strongly positive (++++).

Test systems with Ehrlich's reagent and the fluorescence method help to quantitatively establish bile pigments.

Treatment


Before starting therapy, it is necessary to reliably establish the cause of the appearance or increase of bile products in the blood. Collecting complaints, medical history, and diagnostic test results will help determine the type of disorder as accurately as possible.

Basically, correction of hepatobiliary tract disorders is carried out using traditional methods:

  1. A therapeutic diet is mandatory; alcohol and smoking are contraindicated.
  2. Viral hepatitis is treated using special algorithms.
  3. Detoxification and plasma blood purification are carried out.
  4. Hepatoprotectors and choleretic agents are prescribed.
  5. Supportive (glucose, vitamins) and immunostimulating therapy is used.

Tumors, stones and other mechanical obstacles are subject to surgical removal. The optimal method is selected depending on the type of intervention and failure of conservative therapy.

Unconventional methods of treatment are acceptable in the presence of pathological bile pigments in urine. Usually, special infusions of herbs with hepatoprotective properties or aimed at enhancing biliary function are used. Before use folk ways therapy, it is necessary to consult a specialist to avoid cross-effects of drug interactions.

Prognosis and prevention

With timely diagnosis and treatment of pathologies that lead to impaired excretion of bile pigments, the prognosis is favorable, leading to recovery and elimination of disorders.

To prevent the development of pathologies of the biliary tract it is necessary:

  1. Observe personal hygiene rules.
  2. Lead active healthy image life, eat right.
  3. Treat gastrointestinal diseases in a timely manner.
  4. Get vaccinated against hepatitis.

Video: How to lower bilirubin, thin bile.

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The composition and concentration of substances dissolved in urine reflect the course of all types of metabolism. Unnecessary metabolic products are excreted from the body in the urine if the size of their molecules allows them to pass through the kidney filter. The rest are sent to the intestines.

Bile pigments are present in urine in very small quantities. They are the ones that color urine yellowish. It is impossible to identify this minimum using conventional laboratory methods, and is not considered necessary.

If the color of urine darkens to a “beer shade,” a suspicion arises of an increase in the concentration of bile pigments caused by their increased content in the blood. Conducting a urine test with qualitative and quantitative reactions allows you to make a correct diagnosis.

What bile pigments end up in urine?

There are 2 types of bile pigments found in urine:

  • bilirubin;
  • urobilinogen.

Accordingly, such conditions can be called bilirubinuria and urobilinogenuria.

What is bilirubin?

The breakdown of red blood cells causes an increased release of hemoglobin. It is from this that bilirubin is formed in the liver. The substance can be present in the blood in two states:

  • free bilirubin (unconjugated) – does not pass through the barrier of the renal membrane, which means it is not normally found in urine, despite the increased level;
  • bound (conjugated) - reacts with glucuronic acid, becomes a soluble compound and is excreted into urine, bile, and with it into the intestines.

Transformations occur in liver cells. Bilirubinuria is caused by an increased level of conjugated bilirubin in the blood.


The formation of bilirubin is associated with the process of breakdown of red blood cells

How is urobilinogen formed?

Urobilinogen is a product of the subsequent processing of bilirubin in the intestine by:

  • mucosal enzymes;
  • bacteria.

More modern data indicate the presence of urobilinogen bodies, which include derivatives:

  • mesobilirubinogen,
  • i-ypobilinogen,
  • urobilinogen IX a,
  • d-urobilinogen,
  • "third" urobilinogen.

The last two types and stercobilinogen are synthesized in fairly small quantities and are of no diagnostic value.

The formation of urobilinogen from conjugated bilirubin occurs in the upper part of the small intestine and the beginning of the large intestine. Some researchers believe that it is synthesized by cellular enzymes dehydrogenases in gallbladder with the participation of bacteria.

A small part of urobilinogen is absorbed through the intestinal wall into the portal vein and returns to the liver, where it is completely broken down. The other is processed into stercobilinogen.

Further, through the hemorrhoidal veins, these substances can enter the general bloodstream and are excreted into the urine by the kidneys. Most of the stercobilinogen in the lower intestine is transformed into stercobilin and excreted in the feces. This is the main pigment that provides color to feces.

The normal level in urine is considered to be no more than 17 µmol/l. If urine is briefly exposed to air, urobilinogen is oxidized by oxygen and converted into urobilin. This can be seen by color:

  • urobilinogen is a colorless substance, fresh urine has a straw-yellow tint;
  • after some time, due to the formation of urobilin, it darkens.


Jaundice in newborns is associated with increased breakdown of red blood cells and the transition to their own hematopoiesis

What do urine pigments “tell”?

Taking into account the biochemical transformations and properties of bile pigments, their determination can be considered a reliable sign of liver damage and the inability to cope with the disposal of red blood cell breakdown products.

When bilirubinuria is detected, 2 variants of pathology should be assumed:

  • disruption of the functioning of liver cells (inflammation, loss of number due to replacement by scar tissue, compression by edema, dilated and overcrowded bile ducts), this process is confirmed by checking the content of aspartic and alanine transaminases, alkaline phosphatase, and total protein in the blood;
  • accumulation in the blood of an increased content of hemoglobin from destroyed erythrocyte cells; for clarification, a study of the hematopoiesis process and analysis of bone marrow punctate will be required.

When is the level of bilirubin in urine impaired?

Unconjugated bilirubin appears in the blood in liver diseases:

  • viral hepatitis;
  • toxic hepatitis due to poisoning with toxic substances (medicines);
  • severe consequences of allergies;
  • cirrhosis;
  • oxygen hypoxia of liver tissue in heart failure;
  • metastatic damage to cancer cells from other organs.

But it does not pass into urine due to the impossibility of filtration. Only in the case of renal and hepatic failure with destruction of the nephron membrane can it be detected in urine.

These same diseases are accompanied by the accumulation of conjugated bilirubin. Its level in the blood determines the degree of damage to the liver tissue. The “renal threshold” for bilirubin is considered to be a level of 0.01-0.02 g/l.

If the liver function is not impaired, but the outflow of bile into the intestines is hampered, then a significant amount of bound bilirubin enters the blood and its excretion in the urine increases accordingly. This variant of pathology develops when:

  • cholelithiasis;
  • compression of the bile duct by a tumor of the head of the pancreas or swelling in acute pancreatitis.


Impaired bile outflow leads to high levels of bilirubin in urine

Bilirubinuria occurs as a result of a slow flow of bile in the interlobular ducts (cholestasis), leakage of bile into the blood vessels. The patient is expressed in yellowness of the skin and sclera. The type of jaundice (mechanical or parenchymal, subhepatic or hepatic) is determined by the ratio of free - bound bilirubin in the blood and urine.

An important distinguishing feature of hemolytic conditions is the absence of bilirubinuria.

What is judged by the content of urobilinogen?

In diagnosis, both increased and decreased levels of pigment in the urine are important. Upper growth normal level possible due to:

  1. Damage to the liver parenchyma, but maintaining the flow of the bulk of bile into the intestine. The part of the pigment returned through the portal vein is not processed by hepatocytes due to their functional inferiority. Therefore, urobilinogen is excreted into the urine.
  2. Activation of hemolysis (destruction of red blood cells) - increased synthesis of urobilinogen bodies and stercobilin occurs in the intestine. In this case, the returning part of urobilinogen is broken down by the working liver into the final product (pentediopente), and stercobilin goes through the hemorrhoidal veins into the general bloodstream, the kidneys and is excreted in the urine.
  3. Intestinal diseases - which are accompanied by increased reabsorption of stercobilinogen through the affected wall (prolonged constipation, enterocolitis, chronic intestinal obstruction, cholangitis).

The mechanism of hemolysis is characteristic of diseases such as:

  • malaria;
  • Addison-Beermer anemia;
  • lobar pneumonia;
  • infectious mononucleosis;
  • Werlhof's disease;
  • some types of hemorrhagic diathesis;
  • sepsis.

Massive hemolysis is caused by:

  • complication of massive internal bleeding;
  • transfusion of incompatible blood group;
  • resorption of large hematomas.

Parenchymal failure is secondary to circulatory disorders after myocardial infarction and the development of cardiac weakness. Treatment of liver cirrhosis by applying a shunt to eliminate portal hypertension can be complicated by renal vein thrombosis.

A decrease in urobilinogen concentration indicates:

  • blockage of the biliary tract due to stones or compression by a tumor;
  • inhibition of bile formation up to complete cessation in severe hepatitis and toxic liver damage.

Methods for qualitative and quantitative determination of pigments in urine

Qualitative samples can identify a substance, but do not indicate its mass. Tests for bilirubin are based on the ability to form a green compound (biliverdin) when oxidized with iodine or nitric acid. An iodine-containing solution (Lugol's, potassium iodide, alcohol tincture) is added layer by layer into a test tube with 5 ml of urine.


Bilirubinuria is indicated by the formation of a green ring at the border

To detect urobilin, bilirubin, which interferes with the reaction, is removed from urine with a solution of calcium chloride and ammonia, then various tests are carried out:

  • with copper sulfate - urine is combined with copper sulfate, then with a chloroform solution, after shaking, an intense pink color appears;
  • using a spectroscope – the blue-green part of the spectrum remains.

Depending on the intensity of the color, the following may be marked in conclusion:

  • (+) – the reaction is weakly positive;
  • (++++) – sharply positive.

A detailed determination of the amount of bile pigments in urine is carried out using biochemical reagents in special clinics. The fact is that the study of bile pigments is more indicative of the results of blood tests rather than urine tests.

When is it necessary to check a urine test for bile pigments?

Qualitative tests for bile pigments are included in the mandatory list of standard urine tests. Therefore, if the patient complains of:

  • dyspeptic disorders;
  • vague pain in the hypochondrium on the right;
  • yellowness of the sclera, skin;
  • darkening of urine and light-colored stool;
  • It is necessary to exclude diseases of the liver and gall bladder.

When choosing a method of treating a patient, the doctor must not harm human organs and systems, so analysis is needed to exclude toxic effects medicinal product to the liver.


The appearance of jaundice requires examination for bile pigments

Poisoning with various toxic substances is accompanied by damage to kidney and liver function. By identifying bile pigments, the degree of disorder can be tentatively assumed.

In severe myocardial diseases, a positive test indicates the involvement of liver tissue in the formation of general hypoxia.

Are there any specific features of collecting urine for analysis?

When collecting urine, general requirements should be met:

  • mandatory hygiene of the external genitalia;
  • Only the average portion of morning urine is suitable for research;
  • the container with urine should not be stored for more than two hours, there is no need to leave the transparent jar in the light;
  • 50 ml is enough for analysis.

Bile pigments in urine are involved in the metabolism of important organs and the hematopoietic system. Their determination in urine plays a significant role in diagnosis.


Source: 2pochki.com

Testing urine for the presence of certain groups of organic substances makes it possible to become familiar with the functioning of the body. This kind of analysis is prescribed not only when the patient complains of certain changes, but also as a means of prevention after/during treatment. Timely identification of harmful substances will help get rid of errors in the functioning of the kidneys, other internal organs, eliminate inflammatory processes.

Protein in a general urine test - characteristics and norms

The presence of protein in the urine is one of the symptoms that indicates a malfunction of the kidneys. In some cases, even absolutely healthy people Under the influence of certain factors, urine testing may indicate the presence of protein.

What is the normal level of protein in urine for adults and children?

The level of this substance in urine at the time of morning collection should not exceed 0.033 g/l. However this indicator may vary depending on lifestyle:

  • For people who are engaged in heavy work physical work, for athletes – 0.250 g/day.
  • People who don't lead active image life – no more than 0.080 g/day.

Causes of increased and decreased protein in urine in children and adults

There may be several factors that provoke the appearance of protein in the urine:


Bilirubin in a general urine test - characteristics and norms

During normal functioning of the body, the substance in question is excreted through the liver. When there is an excess of bilirubin in the blood, the function of its extraction is partially performed by the kidneys, which ensures the presence of this component in the urine.

Should there be bilirubin in the urine in children and adults?

In the absence of any pathologies in the functioning of the body, urine testing in children and adults should not show the presence of bilirubin in it.

Causes of bilirubin in urine in children and adults

The presence of the substance in question in the urine indicates a malfunction of the liver/kidneys.

The most common causes of bilirubin in urine are:

Glucose in a general urine test - characteristics and norms

Often, an increase (occurrence) of glucose in the urine occurs due to the inability of the kidneys to carry out reverse suction glucose.

How much glucose should there be in the urine of children and adults according to the norms?

The substance in question may normally be present in urine, but its permissible concentration is limited: no more than 0.8 mmol/l. If, when testing urine, the glucose level exceeds the specified norm, a blood glucose test is prescribed at the same time.

Reasons for the increase (occurrence) of urine glucose in children and adults

The detection of this substance in the urine requires further, more thorough research, which will help establish the exact cause of this pathological phenomenon.

The most likely factors that cause the appearance of glucose in the urine in children and adults are the following:

Urobilinogen in general urine analysis - characteristics and norms

This substance is formed in the intestines from bilirubin. The main role in removing urobilinogen is assigned to the liver, but the kidneys also partially participate in this.

What should be the normal level of urobilinogen in urine in children and adults?

When testing morning urine, the substance in question is not detected in it. In general, no more than 6 mg may be present in the urine of adults and children throughout the day. urobilinogen. Some time after urine collection, urobilinogen is converted to urobilin.

Reasons for the presence (increase) of urobilinogen in urine in children and adults

The reasons that cause this pathological phenomenon when testing urine can be of a different nature:

Bile acids (pigments) in general urine analysis - characteristics and norms

The most common representatives of this group of substances are bilirubin and urobilinogen. Excretion of the components in question occurs through feces, less often through urine.

A distinctive feature of bile pigments when present in urine is its non-standard color: dark yellow, with a green tint.

What should be the normal level of bile pigment in urine in children and adults?

Bile pigments are regularly formed in the body under the influence of enzymes in the intestines. Often the bulk of such substances (more than 97%) are excreted along with feces, in other cases through urine.

The permissible norm of the pigments in question in the urine of adults and children cannot exceed 17 µmol/l. An increase in this indicator is associated with serious diseases.

Causes of occurrence (increase) of bile pigment in urine in children and adults

The reasons causing an increase in the concentration of bile pigments when testing urine can be of a different nature:

Indican in general urine analysis - characteristics and norms

The substance in question is formed as a result of protein decay in the cavity of the small intestine. An increase in the level of indican concentration in the urine does not always indicate pathological conditions: this may be associated with poor nutrition (the predominance of meat foods in the diet).

What should be the normal content of indican in urine in children and adults?

This substance may be present in the urine of healthy people and children, but its amount is limited: 0.005-0.02 g/day. If there is an excess of indigan, the urine will have a blue tint, and the patient will complain of abdominal pain and diarrhea.

Reasons for increased urine indican levels in children and adults

Factors that provoke an increase in the level of indican concentration in the urine are often associated with errors in the functioning of the gastrointestinal tract:

  • Inflammatory, purulent phenomena in the intestines: colitis, peritonitis, intestinal obstruction, chronic constipation, abscesses/abscesses in the intestines.
  • Malignant formations in the stomach, intestines, liver.
  • Diabetes mellitus.
  • Gout.

Ketone bodies in general urine analysis - characteristics and norms

The formation of these substances occurs due to the decomposition of fatty acids. There are several types of ketone bodies: acetone, acetoacetic acid, hydroxybutyric acid.

Detection of the substances in question in urine is important for timely diagnosis and treatment diabetes mellitus.

With inadequate drug treatment of diabetes mellitus, the level of ketone bodies in the urine will increase, which will indicate a deterioration in the functioning of the central nervous system.

How many ketone bodies should be in the urine of children and adults according to standards?

The presence of these substances in the urine of adults and children, even in small doses, is a sign of pathology.

Why do ketone bodies appear in urine in children and adults - reasons

The detection of these substances in urine may indicate the following pathologies:

Hemoglobin in a general urine test - characteristics and norms

This substance is formed during the destruction of the structure of red blood cells, after which the blood masses are replenished with a considerable amount of hemoglobin. The liver is responsible for removing the main part of hemoglobin; the kidneys take part in this process partially.