Bilirubin is a yellow pigment formed during the decay of erythrocytes, more precisely - with the destruction of the non-protein part of hemoglobin - heme.His metabolism in the body affects a large number of organs and systems, therefore it is of great interest for doctors of all specialties.
In the blood, the level of bilirubin is examined in the biochemical analysis, in urine its presence and quantity is determined by a general analysis of this biological fluid.
If the concentration of bilirubin in the blood is increased or the function of the liver is impaired, a significant amount of urine enters the urine. Consequently, the presence of this substance in the blood speaks about liver diseases (cirrhosis, liver failure) or about blood diseases (malaria, anemia, hemolysis).
Types of bilirubin
The total index is made up of an indirect and direct form of bilirubin. He is guided when interpreting the results of tests, and determine whether bilirubin is elevated or not. If bilirubin is common in normal, then it is not necessary to investigate its direct and indirect fractions.
- Bilirubin indirect is formed during the decomposition of heme substances and is a toxic substance that does not dissolve in water, but dissolves well in fats.
- Direct bilirubin is formed in the liver, where it interacts with glucuronic acid and it dissolves well in water and is removed from the body together with bile.
When is the analysis scheduled?
The general analysis of urine for revealing the level of bilirubin and other indicators is prescribed during preventive examinations. A simple test can reveal liver and gallbladder diseases.
The study of urine with the determination of the amount of the main bile pigment is carried out with suspicion of the following diseases:
- cirrhosis of the liver;
- toxic and viral hepatitis;
- suspected spread of metastases;
- mechanical jaundice;
- traumatic liver damage;
- jaundice of newborns;
- cholelithiasis;
- rare hereditary pathologies;
- tumor process in the head of the pancreas.
Detected bilirubin in urine - what does it mean?
In urine, the adult bilirubin content is very small and is not determined by standard methods of research (biochemical analysis of urine, general urine analysis). Therefore, it is believed that normal bilirubin in the urine is absent.
Therefore, the presence of bilirubin in the urine is characteristic when there are diseases that are accompanied by damage cells of the liver, which leads to the ingress of a large number of already bound bilirubin.
The determination of bilirubin in urine is of great informative value in the diagnosis of the diseases listed above. Application of the methodology allows:
- conduct early diagnosis of hepatitis;
- conduct differential diagnosis of mechanical and hepatic jaundice (with bile flow disorders bilirubin in urine is absent);
- authentically to judge the functional state of the liver (bilirubin in urine 17 mmol / l indicates a serious lesion of the liver).
In addition to diseases that cause the death of liver cells, the appearance of bilirubin in the urine is caused by conditions in which the increased production of bilirubin itself occurs.
Bilirubin in the urine of a pregnant woman
In pregnancy, bilirubin in urine may appear from the same causes as in other people. The future mother is not protected from infection with hepatitis, the toxic effects of drugs or the development of cholelithiasis. The growing uterus and increased intra-abdominal pressure worsen the outflow of bile, which may lead to the late appearance of bilirubin in the analysis of urine, as well as the development of jaundice and skin itching.
If bilirubin in the urine is elevated, an in-depth examination is required to exclude serious liver diseases that can cause the termination of pregnancy. What does it mean increased bilirubin in the urine, the doctor will be able to tell. Self-diagnosis and treatment are not always beneficial. Pregnant women are responsible for the lives of two, so medical care must be qualified.
Bilirubin in newborns
Elevated bilirubin is a normal condition in newborns, as the body adapts to the new environment. Hyperbilirubinemia in them does not require treatment, since everything normalizes itself. Children of this age often have this or that degree of jaundice.
But for various reasons, sometimes with an increase in the unbound form of bilirubin, the child can develop nuclear jaundice, which requires intensive therapy.
The causes of increased bilirubin in the urine
Why is bilirubin in the urine elevated, and what does it mean? Bilirubinuria is a symptom of impaired liver function. Causesdetection of bilirubin in the urine varied:
- acute viral hepatitis (in 90% of cases A or B);
- drug hepatitis (overdose of antibiotics, steroids, etc.);
- chronic hepatitis (most often viral etiology);
- neoplasm of the liver;
- biliary liver cirrhosis;
- during pregnancy in later terms, some women may develop cholestatic hepatitis;
- toxic hepatitis (poisoning with hepatotoxic poisons);
- alcoholic hepatitis (chronic alcoholism);
- infectious diseases accompanied by defeat of hepatocytes: leptospirosis, mononucleosis, brucellosis, etc.
In all these cases, urinalysis shows only direct bilirubin, which the liver failed to excrete with bile in the intestine, because is sick, and the enzyme has got into the blood and kidneys. The blood test for direct bilirubin is also above normal.
At the same time, there are disorders in which there is an overabundance of indirect bilirubin (with hemolytic anemia, for example), and then a blood test shows it, and urine analysis does not.
Symptoms
We found out that the main cause of bilirubin in urine is liver disease and the transfer of enzymes into the blood. Therefore, the main symptom of bilirubinuria is jaundice, in which the skin, eyes and mucous membranes of the patient become yellow.
In addition, any hepatic disease is characterized by severity in the right upper quadrant, bitter eructations. Those who are ill complain of frequent nausea. The color of the stool masses also changes, they become practically white. But urine - it's getting dark. Sometimes patients complain of hepatic colic or itchy skin. If you find the above symptoms, immediately go to an additional examination with a specialist.
Depending on the disease (the initial causes of bilirubin in the urine), the appropriate treatment is prescribed. In addition to drug therapy, it is appropriate, and even necessary, a diet.
What to do?
The sooner the indicators return to normal, the lower the risk of intoxication. It is important to remove the decomposition products of hemoglobin in the shortest possible time, to achieve optimal flow rates if the blood is too viscous.
Self-medication is prohibited: the selection of unsuitable herbs and medicines interferes with the outflow of bile, disrupts the work of the affected organs, provokes diarrhea or constipation. Especially dangerous is the uncontrolled intake of interferons for the treatment of chronic hepatitis: potent formulations have a mass side effects, exact selection of the name and dose is required depending on the weight of the patient, the type of disease.
Main methods:
- antiviral drugs for the detection of hepatitis;
- cholagogue in the development of gallbladder pathologies;
- preparations, dissolving stones on a plant basis (urates);
- hepatoprotectors, supporting the liver;
- immunostimulating compositions;
- Droppers with blood purifying compounds, glucose preparations;
- a decrease in the amount of salt per day, a sufficient amount of pure water to eliminate toxins;
- refusal to smoke and all kinds of alcohol;
- diet to reduce the burden on the weakened liver and biliary tract. It is forbidden to drink carbonated drinks, mushrooms, spicy spices and seasonings, garlic, onions, chocolate, smoked products. You should not eat fresh white bread, margarine, refractory fats, muffins, cakes, canned food.
"How to treat a lowered bilirubin in the urine?" This question arises quite rarely, but if a decrease in the level of the bile pigment is detected, it is necessary to be urgently examined not only by a gastroenterologist, but also by a hematologist (specialist in blood diseases) and a phthisiatrician. Treatment is prescribed taking into account the diagnosis, delivered after other tests and tests.
It is important to increase the level of hemoglobin: while the erythrocyte in the blood is too small, the level of the bile pigment will never rise to optimal values.
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