Urobilinogen in Urine: What it is, Range, Causes and Treatment

Urobilinogen in Urine

Although urobilinogen is usually in urine, raised or missing amounts may point to certain health problems. Here’s a brief rundown:

What Do We Mean by Urobilinogen?

Urobilinogen forms when bilirubin is reduced. The liver takes bilirubin which we get from the breakdown of red blood cells. Urobilinogen is made in the gut by breaking down some bile and is eventually absorbed by the blood and removed from the body in urine by the kidneys.

Normal Urobilinogen Range in Urine

Normal urobilinogen in urine: 0.1 to 1.0 mg/dL

High Urobilinogen in Urine

If urobilinogen levels are higher than the normal range in your urine, it generally means the body is processing too much bilirubin or the liver isn’t handling it properly.

High levels of urobilinogen are detected (↑):

Causes:

• Hemolytic anemia is caused by the body’s overproduction of red blood cells.
• Liver Diseases such as hepatitis or cirrhosis
• Infections like malaria which kills red blood cells
• Gilbert’s syndrome

Associated signs:

• Dark urine
• Jaundice
• Fatigue

Low Urobilinogen in Urine

Finding no or little urobilinogen in the urine can often highlight problems with bile and liver activity. Traces are fine, but if isn’t in your system or is very slightly present, this might be a concern.

Little or no urobilinogen in the urine (↓/0):

Causes:

• Blockage of the bile channels by growths (often gallstones or tumors)
• Serious liver harm – when bilirubin cannot be converted by the liver
• When someone is treated with antibiotics, the gut bacteria depended on for urobilinogen may be reduced

Associated signs:

• Pale stools
• Jaundice
• Itching (from bile salt accumulation)

What does urobilinogen in urine mean?

Slight amounts of urobilinogen in urine are considered normal, as it is made from your body’s bilirubin. It shows how your liver gets rid of toxins and if your bile is moving as it should.

What Exactly Is Urobilinogen?

• If red blood cells are broken, they emit hemoglobin and the liver turns it into bilirubin.
• Bilirubin gets passed to bile and then travels to the intestines.
• Part of the bilirubin in the gut is helped by bacteria to become urobilinogen.
• Plenty of urobilinogen is carried back into the blood and then removed by the kidneys through urination.

What Does It mean If Found in Urine?

• Normal range (0.1 and 1.0 mgl/dL) means the liver and red blood cells are working well.
• Extreme: May lead to liver disease, hemolysis (rapid destruction of red blood cells) or a higher level of bilirubin production.
• If the results are low or non-existent: Bile duct obstruction, major liver disease or recent use of antibiotics may be the reasons.

Urobilinogen in Urine Causes

Bilirubin is broken down to urobilinogen in your kidneys and this is found in your urine in small amounts. Both high and low levels may point to possible liver, bile duct or red blood cell problems.

Causes of High Urobilinogen in Urine:

• Liver diseases (hepatitis, cirrhosis)
• Hemolytic anemia
• Infections (malaria, sepsis)
• Gilbert’s syndrome
• Fever, dehydration, or fasting

Causes of Low or Absent Urobilinogen in Urine:

• Bile duct obstruction (gallstones, tumors)
• Severe liver damage
• Cholestasis
• Antibiotic use

Urobilinogen in Urine Symptoms

The presence of urobilinogen in urine often represents a symptom-free marker, but high or low amounts in your urine can signal conditions, primarily of the liver, bile ducts or red blood cells. The symptoms you have are caused by the original causes.

Symptoms Associated with High Urobilinogen:

• Dark urine
• Fatigue
• Jaundice (yellowing of skin or eyes)
• Pale stools
• Right upper abdominal pain
• Enlarged liver or spleen (sometimes)

Symptoms Associated with Low or Absent Urobilinogen:

• Clay-colored or pale stools
• Dark tea-colored urine
• Jaundice 
• Itchy skin (bile salt buildup)
• Nausea, vomiting
• Abdominal bloating or pain

How to treat urobilinogen in urine?

If urobilinogen in urine is abnormal, the best approach is to treat the liver, red blood cells or bile ducts, since that is usually where the problem lies.

First, Identify the cause:

You should first find out why your urobilinogen levels are high or low before starting treatment. It typically means:

• Blood tests for the liver
• Urinalysis
• Blood sampling (Complete Blood Count)
• Imaging studies (Ultrasound, CT scan) are performed when it’s thought that bile duct issues are present.

How High Urobilinogen in Urine Is Treated?

Hepatitis and cirrhosis (liver diseases)

• Treatment for hepatitis includes antivirals, quitting alcohol, using ursodeoxycholic acid and changing habits.

Hemolytic anemia

• To treat autoimmune diseases, use steroids and remove any drugs or infections that worsen the condition.

Infections (malaria)

• Special antibiotic treatment based on the type of infection.

Genetic disorders, for example Gilbert’s

• In most cases, no treatment is necessary for mild cases.

How to treat low Urobilinogen in Urine?

Bile duct obstruction (gallstones or various tumors)

• You may be treated with surgery, through an endoscope (like ERCP) or by having a stent inserted.

Cholestasis

• Treat what is causing the jaundice such as weaning off drugs or prescribing bile flow medicines like ursodiol.

Liver failure 

• May lead to vascular problems which can result in admission to the hospital and possible liver transplant.

Antibiotic use

• The urobilinogen returns to normal after antibiotics are no longer taken. You can treat this by yourself.

Urobilinogen in Urine and Liver Disease

Medical tests indicate that changes in urinary urobilinogen often appear before the signs of serious liver problems.

Urobilinogen and How it is Connected to the Liver

• Bilirubin is produced when the liver breaks apart the hemoglobin from red blood cells.
• After bilirubin enters the intestines, bacteria there change it into urobilinogen.
• A portion of urobilinogen is returned to the kidneys, where some is carried out with urine.
• That’s why changes in your liver’s function or in bile excretion can directly raise urobilinogen levels.

Increased Urobilinogen in Urine Results Can Indicate Problems with the Liver

High levels may be created when:

• There is a difficulty for the liver to process bilirubin (hepatitis, cirrhosis).
• Antibodies are destroying a lot of red blood cells which overtaxes the liver.
• While the intestines are making urobilinogen from a small amount of bilirubin, the liver is unable to eliminate it.

A Low or Zero Level of Urobilinogen in Urine May Indicate a Blockage in Bile Flow

When bile or bilirubin do not reach the intestines:

• Urobilinogen is not created.
• It is a common sign in people with obstructive liver diseases.

Urobilinogen in Urine and Hepatitis

The connection between urobilinogen in urine and hepatitis is high because your liver function which is related to hepatitis influences your urobilinogen levels.

How it works?

• When a person has hepatitis, the liver is inflamed and unable to properly help with bilirubin allotment.
• Bilirubin that reaches the intestines is changed into urobilinogen by bacteria found there.
• Due to liver damage, the liver isn’t able to reuse urobilinogen well.
• Therefore, increased urobilinogen gets carried through the blood and is excreted through the urine.

Urobilinogen is high in Hepatitis:

Acute hepatitis 

• ↑ Elevated
• With an inflamed liver, bilirubin can’t be processed as it should.

Chronic hepatitis    

• ↑ or fluctuating
• It relies on how much damage has happened to the liver.

Severe hepatitis/failure

• ↓ or absent
• When bile does not flow out at all (a very rare condition in late stage).

Urobilinogen in Urine vs Bilirubin

Urobilinogen in Urine

• The substance urobilinogen is produced when gut bacteria change bilirubin, in the intestines, a waste product made in the liver. 
• Some of it passes back into your blood and is expelled from your body in urine. 
• Most of the time, there is a small amount of urobilinogen in urine and its levels can tell you about how the liver is doing and if bile is being produced correctly. 
• When urobilinogen appears in your urine, it might be high, normal or low—and every value means something different.
• If your test shows high urobilinogen, it may be due to liver disease, an increase in red blood cell destruction or liver failure.
• A lack of urobilinogen can be a sign of total bile duct blockage or very serious liver failure, meaning that no bile gets into the intestines.

Bilirubin

• Bilirubin is created when the body breaks up damaged red blood cells. 
• It helps the liver transform toxic drugs into an excreted substance found in bile. 
• Bilirubin doesn’t usually appear in urine since the liver must make it water-soluble before excreting it as conjugated (direct) bilirubin. 
• If the liver is hurt or the bile ducts are obstructed, conjugated bilirubin may move into the blood and afterward into the urine, where it can be detected. 
• Normally, finding bilirubin in one’s urine suggests either a liver disease or blockage of the bile duct. 
• It indicates there is conjugated bilirubin, a water-soluble substance excreted in urine when bile from a damaged or blocked liver or bile ducts escapes.