Bilirubin is primarily derived from metabolism of hemoglobin. Only conjugated bilirubin (=water soluble) is excreted into the urine and normally only trace amounts can be detected in urine. Elevated urinary bilirubin occurs in patients with obstructive jaundice or jaundice due to hepatocellular disease or injury. However, urine bilirubin is relatively insensitive for detection of liver disease. Hyperbilirubinemia due to hemolysis is principally due to unconjugated bilirubin, and therefore does not result in increased urinary bilirubin.
Elevated urinary bilirubin is suggestive of hepatocellular disease or post-hepatic biliary obstruction.
False positive tests may occur if urine is contaminated with stool, or if the patient is taking drugs which cause red coloration of urine.
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