Urobilinogen in Urine - All You Need to Know

Introduction

Urobilinogen is derived from bilirubin. The body makes bilirubin during the normal process of breaking down old red blood cells. The liver uses bilirubin to make bile, a fluid that helps digest food in the intestines. Some bile flows from the liver through ducts (thin tubes) directly to the intestines. The rest is stored in the gallbladder and is used by the body as per its need.

What Is Urobilinogen?

Beneficial bacteria break down bilirubin in bile in the intestine to produce urobilinogen. Some urobilinogen is excreted from the body in feces. Some of it enters the bloodstream, returns to the liver, and is recycled into bile. A small amount of urobilinogen is excreted in the urine. Excess urobilinogen in the urine can signify the presence of underlying liver diseases, such as hepatitis, cirrhosis, or certain types of anemia. Low or absent urobilinogen can be a sign of other problems with the liver, gallbladder, or bile ducts.

What Is the Normal Urobilinogen Level in Urine?

The normal concentration of urobilinogen in the urine is up to 1.0 mg/dL. A result of 2.0 mg/dL represents a transition of urobilinogen from normal to abnormal levels, and the patient urine specimen should be further evaluated for any hemolytic and hepatic disease. Evaluation of both bilirubin and urobilinogen results is useful in the differential diagnosis of jaundice and other hepatobiliary diseases.

What Could Cause Low Urobilinogen Levels in the Urine?

If the test results show little or no urobilinogen in the urine, it may be a sign of:

• Blockage of The Ducts- The ducts that carry bile from the gallbladder and liver to the intestine may be blocked. When these are blocked, bile accumulates in the liver, causing jaundice (yellowing of the skin) due to increased bilirubin levels in the blood.

• Blockage of Blood Flow- Half of the urobilinogen formed is reabsorbed, taken up by the liver through the portal vein, enters circulation, and is excreted through the kidneys. In case of obstruction in the liver circulation, the urobilinogen is not secreted through the kidneys.

• Liver Function Problems- Improper liver functioning may lead to decreased excretion of urobilinogen.

• Certain Drugs- Broad-spectrum antibiotics destroy gut bacteria that may interfere with urobilinogen production. In a study of 18 healthy people, six days of antibiotics reduced fecal urobilinogen levels.

What Are the Signs of Low Urobilinogen Levels in the Urine?

Symptoms of low urobilinogen levels vary depending on the underlying cause. Decreased bile flow may be experienced as:

• Itchy skin.

• Malaise.

• Yellow complexion (jaundice).

• Dark urine.

• Slightly colored or foul-smelling stools.

• Anorexia (eating disorder with low body weight).

• Nausea.

• Vomiting.

• Weight loss.

How Are Low Urobilinogen Levels in Urine Managed?

Treating the underlying conditions that cause low urobilinogen levels is how to manage low levels of urobilinogen. If a person has cholestasis (poor bile flow), liver health can be supported by implementing the following measures:

• Eating a healthy and balanced diet.

• Regularly drinking moderate to large amounts (greater than 2 to 3 cups) of coffee (regardless of the caffeine content).

• Improving the quality of sleep.

• Eating more foods that help the liver and kidneys detoxify, such as asparagus, cabbage, and broccoli.

• Drinking more water.

• Buying organic meats and vegetables whenever possible to avoid liver-damaging chemical additives and pesticides.

• Going to a sauna, as saunas are beneficial for expelling toxins from the body.

• Limiting alcohol consumption as excessive alcohol damages liver cells and can exacerbate the existing liver disease.

• Consuming drugs and supplements only after its reviewed by a doctor as some drugs and supplements can damage the liver.

What Causes a Spike in Urobilinogen Levels?

The causes of raised levels of urobilinogen are listed below:

1. Liver Disease - Some liver diseases, such as cirrhosis, hepatitis, and liver cancer, can increase the amount of bilirubin and lead to high levels of urobilinogen in the urine. It can occur in liver problems before it appears. Therefore, if high levels of urobilinogen are detected in the urine, the doctor should also order other blood tests, such as a complete blood count and liver enzyme test.

2. Blood Cell Abnormalities - Under certain conditions, the body can produce antibodies that attack red blood cells, destroying them. As a result, the level of bilirubin in the blood increases. This can be detected by blood tests or high levels of urobilinogen in the urine. Hemolytic anemia is also associated with elevated bilirubin levels and splenomegaly. The spleen helps filter the blood to remove old red blood cells and produces and stores white blood cells. An inflamed spleen does not function properly and can lead to elevated bilirubin.

3. Biliary Disease - Some diseases, such as cholestasis (blockage of the bile ducts) and cholangitis (inflammation of the bile ducts), can lead to increased levels of urobilinogen in the urine.

4. Malaria - The presence of urobilinogen in urine is an associated sign of severe malaria with the following complications:

• Thrombocytopenia (low platelet count).
• Nerve dysfunction.
• Liver failure.

What Are the Signs of High Urobilinogen Levels in Urine?

Symptoms of high levels of urobilinogen in urine depend on the underlying cause.

1. In the presence of an underlying liver and gall bladder disease, the following may be experienced:

• Yellowing of the skin and eyes (jaundice).

• Dark urine.

• Nausea and vomiting.

• Cold.

• Heat.

• Loss of appetite.

• Weakness or fatigue.

• Disorientation or confusion.

2. If the underlying cause of high urobilinogen in the urine is a breakdown of red blood cells, then the following may be experienced by the person:

• Dark urine.

• Back pain.

• Yellow skin (jaundice).

• Fast heartbeat (tachycardia).

• Anemia.

How Are High Urobilinogen Levels Managed?

Increased levels of urobilinogen can be managed in the following ways:

1. Treating Underlying Conditions - Treat underlying conditions that cause low urobilinogen levels. Talk to the doctor to understand the primary cause of decreased levels of urobilinogen and what appropriate treatments are available.

2. Limiting Alcohol Intake - Excessive alcohol consumption can damage liver cells and exacerbate the existing liver disease. Alcohol can also deplete red blood cells and exacerbate anemia.

3. Reviewing The Medications - Some medications can damage the liver. Have the medications review the medications which could harm instead of heal. Following medications may be toxic to the liver.

• Paracetamol.

• Aspirin.

• Non-steroidal anti-inflammatory drugs.

• Methyldopa.

• Amiodarone.

• Monoamine oxidase inhibitors.

• Phenothiazines (such as Chlorpromazine).

• Sodium valproate.

• Oral contraceptives.

• Hormone replacement therapy.

• Vitamin A.

4. Improving Sleep Quality - Good sleep is essential for liver health. Short sleep duration and poor sleep quality significantly increase the incidence of non-alcoholic fatty liver disease (NAFLD).

5. Exercise - Exercisehelps people with anemia caused by the destruction of red blood cells. Moderate physical activity signals the body to produce more red blood cells to facilitate muscle oxygenation. This is why endurance athletes often suffer from anemia.

How Are Urobilinogen Levels in Urine Tested?

Urobilinogen is most commonly measured in urine. This is usually done as part of a urinalysis to measure many other substances in the urine (proteins, ketones, and glucose). Urinalysis is often part of a routine physical examination to look for early signs of illness. Urobilinogen levels in the stool can also be measured (although this is done occasionally).

Conclusion:

Urobilinogen is a colorless compound formed in the intestine by the reduction of bilirubin. Some are excreted in the feces, where it is oxidized to urobilin. Some are reabsorbed and excreted as bilirubin in the bile. Sometimes it is excreted in the urine and later oxidized to urobilin. Increased and decreased levels can be a sign of liver problems. Testing urobilinogen in the urine can reveal a lot about the underlying health of a person.