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What Tests Do You Recommend For Elevated Urine Bilirubin?

Posted on Mon, 3 Feb 2014

Question: My doctor has informed me that the bilirubin in my urine was "extremely elevated" but my blood profile showed my liver functions were normal. Frankly, she is stumped and said she would need to do some research. I have been an alcoholic in recovery for 4 years. Prior to that, my liver panels were high, and I had a fatty liver. Since I quit drinking, my levels returned to normal. I am a 53 year old female, hbp and "pre" diabetic. What tests would you recommend.

Answered by Dr. Chobufo Ditah (1 hour later)

Brief Answer: Check the blood bilirubin Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about this elevated urine bilirubin. Bilirubin is a breakdown product of red blood cells. It is mainly eliminated through feces and that is what gives the color to feces. When there is a problem with the elimination of this which is mainly an obstruction of the bile ducts, it gets eliminated through the urine. You would need a more comprehensive evaluation of your bilirubin numbers. This will tell us whether there is a problem with the numbers in blood or not. depending on the preliminary findings, further investigations like imaging studies and more robust blood tests would be done. If it is isolated increased bilirubin in urine, monitoring may be the only thing to do. In a, I recommend blood testing for a comprehensive liver panel including total bilirubin, free and conjugated bilirubin. Other decisions would be made based on this. I hope this addresses your query fully. I wish you well. Feel free to ask for clarifications if need be. Thanks. Dr. Ditah, MD.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chobufo Ditah (1 hour later)

Is a blood bilirubin test a particular blood test, or would it be included in the normal liver panel that I took? As stated above, these levels were within normal range. Thank you for your response.

Answered by Dr. Chobufo Ditah (15 minutes later)

Brief Answer: It must be specified to be done! Detailed Answer: Hi and thanks for following up with me. This test needs to be specified on the liver panel test to be done. Can you please upload the test results so that i can review and give specific answers? If it were done and the values normal, then just stay calm and follow up with a control in about 2-3months. Thanks and hope this helps. I wish you well. Feel free to follow up with me. Dr. Ditah, MD.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chobufo Ditah (2 days later)

I've received a copy of my labs, which also has a history of all lab work for me since 2010. All bilirubin blood and urine tests are within the normal limits; however, my urobilinogen levels are as follows: 10/2010: 0.2, 04/2011: 0.2, 10/211: 4.0, 11/2012: 4.0 and my latest one on 1/08/14: >8.0. Obviously, there has been a pattern of increase, albeit slowly. What would you advise now?

Answered by Dr. Chobufo Ditah (2 days later)

Brief Answer: Thanks Detailed Answer: Hi and thank you so much for following up with me. I am so happy for this detailed results that shows the exact trend over time. Bilirubin can only spill into urine if there is a problem with its excretion. This means the problem could be at the level of the excretory bile ducts. This will require imaging studies like an ultrasound and a CT scan to look at these structures for possible obstruction. A gastro-enterologist would be the best person to evaluate these structures for possible obstruction. In obstruction, the blood levels should also be increased but it is not the case with you which makes it somewhat not typical. Also, the concentration of substances in urine is closely controlled by the urine concentration. I hope you have not been doing these tests after periods of limited fluid intake or intense sweating. I hope you find this helpful and guiding. I wish you well. Dr. Ditah, MD.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chobufo Ditah (18 hours later)

Thank you, Dr. Ditah, for your response. I'm not sure if this has any bearing on your answer, but I had my gall bladder removed in 1982. Again, I appreciate your input, as I will be returning to the lab tomorrow morning to follow up on my potassium level, which was a little low. I was going to check with her nurse to make sure my doctor had not forgotten about my levels, since I don't have another appointment scheduled for another 6 months.

Answered by Dr. Chobufo Ditah (16 minutes later)

Brief Answer: THanks Detailed Answer: Thanks for following up with me. With your gall bladder already removed, the possibility of obstruction are even lower because the bile never gets stored which can easily lead to this. With every other finding normal, it may simply turn out to be an abnormal observation without any potential consequences to your health. It will be a great idea to get it controlled in the months ahead. Remind her about it. If I may ask, what is the cause of your low potassium levels??? Any ideas? Thanks and I wish you well. Dr. Ditah, MD.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chobufo Ditah (6 minutes later)

I'm on Losartan for HBP. My potassium and sodium levels both tend to be on the low side, and occasionally, I need a little extra potassium. The only other significant reading on my lab test was my Vitamin D level, which was 12.3. I'm now taking 2000 mgs/day.

Answered by Dr. Chobufo Ditah (1 hour later)

Brief Answer: Thanks Detailed Answer: Thanks for providing me with this additional piece. Lorsartan is not typical to cause low potassium. I hope the numbers come out better when controlled. Banana is rich in potassium and could be a good source of supplementation for you if you would like to. Also, spending ore hours outdoors when it is XXXXXXX would help improve your VitD levels. I hope your calcium was checked and your bone density assessed, too. I wish you well. Dr. Ditah, MD.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar