Urobilinogen in Urine: Low & High Levels + Normal Range

Urobilinogen in Urine: Low & High Levels + Normal Range

Urobilinogen in Urine: Low & High Levels + Normal Range

Urobilinogen is a byproduct of bilirubin that is eventually eliminated through the stool and urine. Although urobilinogen is normally found in the urine, higher or lower levels may be a sign of a liver problem. Read on to find out what urobilinogen is, how it can be tested, and what its levels may reveal about your health.

What is Urobilinogen?

Urobilinogen is a colorless pigment produced from the breakdown of bilirubin by gut bacteria. The majority of this compound is excreted in feces, and a small amount is reabsorbed and excreted in the urine [1].

When bilirubin production increases because of red blood cell destruction (hemolysis) or liver disease, urobilinogen levels rise in the urine.

On the other hand, when insufficient bilirubin reaches the gut due to decreased bile flow, urobilinogen production is reduced, resulting in extremely low or absent urinary urobilinogen levels.

For these reasons, a urobilinogen test is used with other tests to help detect liver, gallbladder, or red blood cell problems [1, 2].

Urobilinogen Tests

Urobilinogen is most commonly measured in the urine. This is usually done as part of a urinalysis test, which measures many other substances in your urine, including proteins, ketones, and glucose. A urinalysis is often part of a routine health exam to screen for early signs of disease [3].

Your doctor may also order this test to monitor existing liver conditions, or if you have symptoms of liver disease. These include [4, 5, 6]:

  • yellowing of the skin and eyes (jaundice)
  • dark-colored urine
  • nausea and vomiting
  • itchy skin
  • pain and swelling in the abdomen
  • chills
  • fever
  • loss of appetite
  • weakness/fatigue
  • disorientation or confusion

Urobilinogen levels can also be measured in the stool (although this is not done as often).

Normal Levels

Urobilinogen is normally found in trace amounts in the urine (0.2 – 1.0 mg/dL) [7].

Urobilinogen levels < 0.2 mg/dL are considered low.

Urobilinogen levels > 1.0 mg/dL are considered high [8].

However, these values vary from lab to lab.

Limitations

One study found that although the urine urobilinogen test was a good screen for elevated blood bilirubin levels, it was not as useful for detecting liver problems due to a high proportion of false-negative results [9].

The urobilinogen test, by itself, is not enough to diagnose any condition. Talk to your doctor about what your test results mean and how to manage any underlying health conditions [10].

Symptoms

Symptoms of low urobilinogen levels depend on the underlying cause. If you have reduced bile flow, you may experience [11, 12]:

  • Itchy skin
  • Fatigue
  • Yellow complexion (jaundice)
  • Dark urine
  • Lightly colored or foul-smelling stool
  • Anorexia
  • Nausea
  • Vomiting
  • Weight loss

1) Reduced Bile Flow

Cholestasis, or reduced bile flow from the liver to the intestines, can cause bilirubin to build up in the bloodstream instead of being eliminated normally. This can reduce the production of urobilinogen, which leads to lower levels in the urine [1, 13].

Urinary urobilinogen levels were significantly lower in infants with biliary atresia (narrow, blocked, or absent bile ducts) compared to healthy infants in an observational study of 75 infants [13].

Causes of cholestasis include [12]:

  • Bile duct blockage (gallstones, cysts, and tumors)
  • Liver disease/damage
  • Pregnancy
  • Severe infection
  • Pancreatic cancer

Generally, if you have symptoms of liver disease and bilirubin in your urine but an absence of or low urobilinogen, this suggests that not enough bile is flowing to your gut [1, 5].

2) Certain Medications

Broad-spectrum antibiotics destroy gut bacteria, which can prevent the production of urobilinogen [1].

In a study of 18 healthy people, antibiotic treatment for 6 days reduced urobilinogen levels in the stool [14].

False Negative Results

Some factors can interfere with your lab tests and cause false negative results. These include [1, 3, 15, 8]:

  • Exposure of urine sample to direct sunlight – urobilinogen breaks down when exposed to sunlight
  • Substances that acidify urine (e.g. vitamin C)

1) Treat Underlying Conditions

Address any underlying conditions that are causing low urobilinogen levels.

If you have cholestasis (reduced bile flow), promote the health of your liver by:

  • Eating a well-balanced diet [16]
  • Drinking moderate to high (> 2-3 cups) amounts of coffee (regardless of caffeine content) on a regular basis [17, 18]
  • Getting more quality sleep [19]
  • Eating more foods that can help detoxify the liver and kidneys such as asparagus, cabbage, and broccoli [20]
  • Drinking more water [20]
  • Buying organic meats and vegetables whenever possible to avoid chemical additives and pesticides that damage the liver [21]
  • Going to the sauna – saunas are beneficial for decreasing toxins in the body [22]
  • Limiting your alcohol intake – excess alcohol can damage liver cells and worsen existing liver conditions [23]
  • Reviewing your medications – some drugs or supplements can damage the liver. Have a doctor or pharmacist review your medications to see if any could be harmful to the liver [24, 5]

2) Review Your Medications

If you are taking antibiotics, discuss lowering your dose or alternative options with your doctor.

1) Liver Disease or Damage

Liver damage and disease (e.g., viral hepatitis and liver cirrhosis) can increase bilirubin levels, resulting in higher urobilinogen levels in the urine [1].

Urobilinogen levels also correlate with blood levels of liver enzymes (e.g. ALT, AST), which rise in response to liver damage [26].

2) Excessive Red Blood Cell Breakdown

Conditions that increase the destruction of red blood cells (e.g. hemolytic anemia, pernicious anemia, intravascular hemolysis, congestive heart failure) raise bilirubin levels, which increases the production of urobilinogen in the gut [1, 27, 3].

Usually, if you have excess red blood cell destruction (hemolysis), you will have urobilinogen in your urine but undetectable amounts of bilirubin [1, 28].

3) Malaria

Urobilinogen levels were higher in 365 malaria patients [29].

Another study of 620 people with malaria found that the presence of urobilinogen in the urine was associated with an increased risk of severe malaria with the following complications [30]:

  • Thrombocytopenia (low platelet count)
  • Neurological dysfunction
  • Liver dysfunction

False Positive Results

Factors that can lead to false-positive results include [8]:

  • Elevated nitrate levels in the urine
  • High carbohydrate intake
  • Timing (test is done later in the afternoon)
  • Drugs that make the urine red, such as phenazopyridine (Pyridium)

2) Limit Your Alcohol Intake

Drinking too much alcohol can damage liver cells and worsen existing liver conditions [23].

Alcohol also decreases red blood cells, which may exacerbate anemia. One observational study of 17.7k people found that red blood cell count was reduced by alcohol consumption, with even the lowest intake showing a significant decrease in red blood cells [31].

3) Review Your Medications

Some drugs or supplements can damage the liver [5, 24]:

  • Paracetamol (Tylenol)
  • Aspirin
  • Non-steroidal anti-inflammatory drugs
  • Methyldopa
  • Amiodarone
  • Monoamine oxidase inhibitors
  • Phenothiazines (such as chlorpromazine)
  • Sodium valproate
  • Oral contraceptives and hormone replacement therapy
  • Chaparral leaf
  • Ephedra
  • Gentian
  • Germander
  • Kava
  • Senna
  • Vitamin A
  • EGCG [32]

Have a doctor or pharmacist review your medications to see if any could be harmful to the liver.

4) Improve Sleep Quality

Good sleep is essential for liver health. Short sleep duration and poor sleep quality significantly increased the incidence of non-alcoholic fatty liver disease (NAFLD) in an observational study of 69k people [19].

5) Drink More Coffee

Drinking moderate to high amounts of coffee (regardless of caffeine content) on a regular basis may benefit liver health. In an observational study of 28k people, drinking more than 3 cups of coffee per day was associated with lower levels of liver enzymes (e.g. ALT, AST, ALP, and GGT) [17].

6) Exercise

If you have anemia resulting from red blood destruction exercise may help. Moderate physical activity signals the body to produce more red blood cells to increase the oxygen supply to your muscles [33].

However, avoid more intense and strenuous forms of exercise, as these can damage and destroy red blood cells. This is one of the reasons endurance athletes often have anemia [34].

Source: https://selfhacked.com/blog/urobilinogen/

Back to the Basics: Demystifying the UA

Urobilinogen in Urine: Low & High Levels + Normal Range

Amongst the various diagnostic studies that can be obtained in the ED, urinalysis is a virtually ubiquitous test.

Urine itself reflects the functioning of the human body in both health and disease and the values it comprises can give us information regarding a myriad of conditions from infections, metabolic or endocrine derangements, and toxidromes to neoplastic processes and pregnancy.

Despite this, many of the elements of even the standard urinalysis are often overlooked and underappreciated. In this talk we will explore some of these values and hopefully gain a renewed respect for the “golden cup of answers” and all that it may reveal.

Elements of Urinalysis

Let’s take a few moments to review the values that are tested on a standard urinalysis dipstick.(1,2)

Color (reference yellow/straw):

Color can be abnormal in a wide range of pathology. Amber color can indicate concentration as seen with dehydration. Red urine can indicate hematuria, myoglobinuria, or may be explained by something as benign as the sliced beets your patient had with their most recent meal.

Clarity (reference clear):

Normal urine is clear, but can become turbid with various types of contaminants such as cellular debris, casts, crystals, or protein, and vaginal discharge, bacteria, or sperm.

Specific Gravity (reference 1.005 – 1.035):

In the broadest sense, specific gravity is a term that describes the density of a given substance relative to a reference substance, usually water.

In physiologic terms, this value reflects the kidney’s ability to concentrate urine as well as the body’s overall hydration status.

Low values are seen when urine is dilute, such as with diabetes insipidus or acute tubular necrosis, and high values indicate concentration or increased solutes such as in dehydration or proteinuria.

pH (reference 5.0 – 8.0):

pH can vary under normal circumstances by diet, with high protein diets yielding more acidic values. Acidic urine can also be the result of drugs, metabolic derangements such as DKA, dehydration, and diarrhea. Alkaline urine is found with various drugs (think salicylates and acetazolamide), infection with certain types of bacteria, and acute and chronic renal failure.

Protein (reference negative mg/dL)

Increased protein indicates impairment of the glomerular filtration apparatus.

Common ED diagnoses that will exhibit proteinuria include congestive heart failure and diabetes, but it is also found in glomerulonephritis, pyelonephritis, preeclampsia and malignant hypertension.

Albumin is the primary type of protein that will appear in urine, but other types can be found in states such as multiple myeloma. These other types are not detected on standard urine dipsticks.

Glucose (reference negative)

Glucose should be reabsorbed by the proximal tubules under normal conditions. When serum glucose concentration rises above 180 mg/dL then this reabsorptive capacity becomes overwhelmed and glucose will begin to appear in the urine.

This is primarily observed in patients with diabetes mellitus, but can also be found in thyrotoxicosis, intravenous glucose administration, catecholamine surges, liver dysfunction, acute pancreatitis, and asphyxia (such as with CO poisoning).

Ketones (reference negative)

Ketone bodies reflect altered cellular metabolism when there is an inadequate supply of glucose to meet an increased metabolic demand.

When glucose stores are depleted (or inaccessible as with type 1 diabetes), cells turn to using lipids instead, and ketones are the breakdown product of that process.

They are commonly elevated in vomiting, diarrhea, and malnutrition, as well as pregnancy and hyperthyroidism, and are part of the diagnostic criteria for DKA.

Bilirubin (reference negative) and Urobilinogen (reference 0.2 – 1.0/EU/dL)

Bilirubin is a breakdown product of hemoglobin, and is normally reduced in the intestine to be excreted in urine as urobilinogen. Normally there is no bilirubin in urine, but when present it indicates liver disease.

The pattern of obstructive disease includes elevated bilirubin and low urobilinogen. Hemolytic processes may show elevated urobilinogen as more hemoglobin than normal is processed. Urobilinogen can also be elevated when damage to liver parenchyma prevents its metabolism back to bilirubin.

Specific processes include hepatitis, cirrhosis, pancreatic cancer, and choledocholithiasis.

Blood (reference negative)

Blood can be present in three possible forms: hematuria (results from whole red blood cells), hemoglobinuria (free hemoglobin), and myoglobinuria. A few red blood cells per HPF is normal in urine, but gross hematuria or myoglobinuria is unmistakeable even by simple visual inspection of its color.

Specific conditions that can cause hematuria include many renal disorders such as calculi, neoplasms, infection, and drugs. Myoglobinuria will appear as blood on macroscopic exam with an incongruently small number of red blood cells on microscopic analysis and is usually the result of muscular trauma.

Nitrite (reference negative) and Leukocyte esterase (reference negative)

These values are the hallmarks of urinary tract infection. Nitrite is a product of the conversion of endogenous nitrates to nitrites and has high specificity for gram negative bacteriuria. Leukocyte esterase is an enzyme produced by white blood cells, usually in response to infection.

Red blood cells in urine can be transient but normal in pediatrics, but in adult patients requires further evaluation. The source can be either glomerular or non-glomerular (supported by the presence or absence of RBC casts, respectively), or extra-renal (consider renal calculi, neoplasms, trauma, and infections).

WBCs (reference 0-5/HPF)

Generally, the presence of white blood cells indicates infection, which is often supported by nitrites and/or leukocyte esterase and the presence of bacteria. Sterile pyuria, or WBCs without these concomitant features, can be seen in patients with UTI being treated with antimicrobials, contaminated samples, and infection with atypical organisms such as Chlamydia and tuberculosis.

Squamous Epithelium (reference 0-5/HPF)

Elevated squamous epithelial cells should make the clinician suspicious of contaminated sample.

Bacteria (reference none/HPF)

Bacteria are usually a strong indicator of infection, particularly when present along with the other markers discussed above. When present with WBC casts, the clinician should suspect pyelonephritis as opposed to simple cystitis. When present together with a high number of squamous epithelial cells, the result should be regarded as contaminant.

Mucus (reference none/HPF)

Mucus presence is nonspecific but can be elevated in a variety of conditions including infection, neoplasms, and renal calculi. It can also be a contaminant from vaginal or anal sources.

Sediment (reference none)

Sediments are a mixed-bag of cells, crystals, casts, and microorganisms that give clues to what structures along the urinary tract may be involved, what organisms are present, and what physiologic conditions exist in the kidneys, bladder, and body beyond the urinary system.

Having reviewed the above information, let’s now attempt to apply it to some cases. However, let’s do so with a twist: we’ll work backwards from the urinalysis results to history and physical exam and then discuss other tests and treatments that you might wish to order your findings.

What is your differential for this patient ly on what you see on urinalysis? Certainly urinary tract infection seems ly given the cloudiness and positive nitrites and leukocyte esterase. However, let’s not stop there since we have at least one other abnormality: trace blood.

This could still go along with an infectious picture, but we start to have to consider other entities such as stones, neoplasm, or drugs. However, for this case let’s let Occam’s razor do some work for us and put UTI at the top of our list.

We still don’t know where in the tract this infection may reside, but our urinalysis has more information yet to reveal in the microscopic analysis.

Microscopic results demonstrate 5 RBCs, 50 WBCs, 2 squam, WBC casts, and numerous gram negative rods. So this clearly appears to be an infection based solely on what we can determine on UA.

Even better, we are able to differentiate lower UTI from upper the microscopic analysis showing WBC casts. Recall that casts are a type of sediment that are formed in the renal tubules. Therefore, if we’re seeing casts there must be tubular pathology of some kind.

RBC casts might make us think of glomerulonephritis, but in this case the WBC casts clearly point to pyelonephritis when taken in context with the other findings.

In an equivocal sample you should also make note of the specific gravity because in the case of very concentrated or dilute samples one might get false positive or false negative results.(3)

We’ve practically made our diagnosis without ever speaking to or examining our patient, but let’s not forget the importance of the history and physical exam.

In interviewing your patient you find a 22-year-old female who is otherwise healthy with no meds or allergies who complains of dysuria for the past week and flank pain and fevers since yesterday. On exam she is febrile to 101.

2, hemodynamically stable, and has suprapubic and left flank tenderness.

What factors should we consider when initiating treatment? Patient factors and microbiology will drive your decision, and in this case we have a young woman with no comorbidities or allergies with what appears to be uncomplicated pyelonephritis.

This patient will ly be a candidate for outpatient therapy and antibiotic choice should offer gram negative coverage, ly a fluoroquinolone or cephalosporin. Let’s for the sake of argument say that there were no casts on UA, and our patient had no fevers or flank pain.

In other words simple cystitis.

You would want to be sure that she was symptomatic before prescribing antibiotics as studies have shown that any one of the UA findings in isolation (nitrites, leukocyte esterase, bacteria) without symptoms does not indicate a clinically significant UTI and should not be treated with antimicrobials.(4)

Again we’ll start with the UA and build a differential the values. Here we see dark urine that is positive for blood and protein.

The differential for hematuria and proteinuria is broad, including transient proteinurias (febrile and exercise-induced), orthostatic and postural proteinuria, post-streptococcal glomerulonephritis, Alport syndrome, and a host of glomerular and tubulointerstitial diseases.

4 It looks this case may not be as straightforward as our last one, so we’re going to need the history and physical in order to make the diagnosis. First, let’s be sure to check the microscopic analysis, which shows numerous RBCs, RBC casts, and no WBCs or bacteria.

Again, it is important to note the specific gravity when interpreting results as very concentrated or very dilute samples can give false positives or negatives, respectively.(5)

Our patient turns out to be a 10 year old boy with no prior medical history who comes with poorly localized abdominal pain, fevers, malaise, and facial swelling. We discover that three weeks ago he had a sore throat that resolved without medical attention. On physical exam he appears ill, is hypertensive, and has periorbital and pedal edema, but normal heart and lung sounds.

The case appears to be one of acute post-streptococcal glomerulonephritis. Additional studies for this patient will also include CBC and renal panel in the ED, and he will ly be admitted for further testing, formal renal ultrasound, and possibly biopsy. The only management in the acute setting is supportive care.

Urinalysis is one of the most versatile and readily available diagnostic tests that we as clinicians have available.

Many of the important elements are assessed visually, or at most require widely available dipstick tests, and so the UA can provide answers even in rural or austere settings.

By understanding what each element can tell us individually, recognizing the patterns that they present in combination, and placing that information into the clinical context of our patient, there is almost no disease process in which the urinalysis cannot help make a diagnosis.

  1. Cyriac J, Holden K, Tullus K. How to use… urine dipsticks. Arch Dis Child Educ Pract Ed. 2016;

  2. Interpretation of Bedside Urinalysis. Retrieved April 04, 2017, from https://lifeinthefastlane.com/investigations/urinalysis/

  3. Chaudhari PP, Monuteaux MC, Shah P, Bachur RG. The Importance of Urine Concentration on the Diagnostic Performance of the Urinalysis for Pediatric Urinary Tract Infection. Ann Emerg Med. 2017

  4. Schulz L, Hoffman RJ, Pothof J, Fox B. Top Ten Myths Regarding the Diagnosis and Treatment of Urinary Tract Infections. J Emerg Med. 2016

  5. Kaplan BS, Pradhan M. Urinalysis interpretation for pediatricians. Pediatr Ann. 2013;42(3):45-51.

Source: http://www.tamingthesru.com/blog/grand-rounds/intern-diagnostics/urinalysis

Dipstick urinalysis • LITFL • CCC Investigations

Urobilinogen in Urine: Low & High Levels + Normal Range

Urinalysis (UA) is used as a screening and/or diagnostic tool to detect substances or cellular material in the urine associated with metabolic disorders, renal dysfunction or urinary tract infections (UTI). Often, substances such as protein or glucose will begin to appear in the urine before patients are aware that they may have a problem.

Urine may be assessed both at the bedside (dipstick) and in the laboratory (microscopy, culture, sensitivity and urinary electrolytes). Urine for laboratory analysis must be transferred quickly and at the correct temperature otherwise breeding ground for contaminants.

Dipstick Urinalysis

  • Multistix urinalysis test kits (e.g. ChoiceLine 10).  Urine dipstick costs 30c and takes 3 minutes – MCS costs $12 and takes 1 hour.
  • A totally negative dipstick test is associated with negative microscopy in 90-95% of cases (false negative rate 5-10%) [Reference 1]

Dipstick Urinalysis chart

Specific Gravity (1.002 – 1.035)

  • Specific gravity of urine is a measure of the amount of solutes dissolved in urine as compared to water (1.000).
  • Specific Gravity measures the ability of the kidney to concentrate or dilute the urine and is directly proportional to urine osmolality (solute concentration).
  • Specific gravity between 1.002 and 1.035 on a random sample is normal IF kidney function is normal.

Decreased: 1.022 after a 12 hour period without food or water, renal concentrating ability is impaired and the patient either has generalized renal impairment or nephrogenic diabetes insipidus.

  • Falsely low specific gravity can be associated with alkaline urine
  • Fixed: 1.010

    • The glomerular filtrate in Bowman’s space ranges from 1.007 to 1.010, any measurement below this range indicates hydration and any measurement above it indicates relative dehydration
    • In end stage renal disease, specific gravity tends towards 1.010.
    • Chronic Renal Failure (CRF), Chronic glomerulonephritis (GN)

    Increased: >1.035

    • Increased specific gravity indicates a concentrated urine with a large volume of dissolved solutes
    • Dehydration (fever, vomiting, diarrhea), SIADH, adrenal insufficiency, pre-renal renal failure, hyponatraemia with oedema, liver failure, CCF, nephrotic syndrome
    • Elevation in specific gravity also occurs with glycosuria (e.g. diabetes mellitus or IV glucose administration), proteinuria, IV contrast, urine contamination, LMW dextran solutions (colloid)

    pH (4.5-8.0)

    • The kidneys play an important role in acid-base regulation within the body to maintain a normal urinary pH range between 5.5 – 6.5 but it may vary from as low as 4.5 to as high as 8.0.
    • The glomerular filtrate of blood plasma is usually acidified by renal tubules and collecting ducts from a pH of 7.4 to about 6 in the final urine.
    • Control of pH is important in the management of several diseases, including bacteriuria, renal calculi, and drug therapy.

    High Urinary pH (Alkali Urine)

    • Vegetarian diet, low carbohydrate diet or ingestion of citrus fruit (although citrus fruits are acidic – the digestion process leaves an alkali ash)
    • Systemic alkalosis (metabolic or respiratory)
    • Renal tubular acidosis (RTA I (distal)), Fanconi syndrome
    • Urinary tract infections (bacteriuria with urea splitting organisms)
    • Drugs: Amphotercin B, carbonic anhydrase inhibitors (acetazolamide), NaHCO3, salicylate OD
    • Stale ammoniacal sample (left standing)

    Low Urinary pH (Acidic urine)

    • High protein diet or fruits such as cranberries
    • Systemic acidosis (metabolic or respiratory)
    • Diabetes mellitus, starvation, diarrhoea, malabsorption
    • Phenylketonuria, alkaptonuria, renal tuberculosis

    Protein

    • Normal daily protein excretion should not exceed 150mg/24 hours or 10mg/100mL. Proteinuria is defined by the production of >150mg/day with nephrotic syndrome producing >3.5g/day
    • Dipstick urinalysis detects protein with Bromphenol blue indicator dye and is most sensitive to albumin and less sensitive to Bence-Jones protein and globulins. Trace positive results are equivalent to 10 mg/100 ml or about 150 mg/24 hours (the upper limit of normal).

    True protein elevation:

    • Renal: Increased renal tubular secretion,increased glomerular filtration (glomerular disease), nephrotic syndrome, pyelonephritis, glomerulonephritis, malignant hypertension
    • CVS: Benign HT, CCF, SBE
    • Functional proteinuria (albuminuria): fever, cold exposure, stress, pregnancy, eclampsia, CHF, shock, severe exercise
    • Other: Orthostatic proteinuria, electric current injury, hypokalaemia, Cushing syndrome
    • Drugs: Aminoglycosides, gold, amphotericin, NSAID, sulphonamides, penicillins
    • False Positive: Concentrated urine (UO7.5), trace residue of bleach, aceazolomide, cephalosporins, NaHCO3
    • False Negative: Dilute urine (UO >5.0 litres/day) or acidic urine (pH

    Source: https://litfl.com/dipstick-urinalysis/

    Urobilinogen in Urine: MedlinePlus Lab Test Information

    Urobilinogen in Urine: Low & High Levels + Normal Range
    URL of this page: https://medlineplus.gov/lab-tests/urobilinogen-in-urine/

    A urobilinogen in urine test measures the amount of urobilinogen in a urine sample. Urobilinogen is formed from the reduction of bilirubin.

    Bilirubin is a yellowish substance found in your liver that helps break down red blood cells. Normal urine contains some urobilinogen. If there is little or no urobilinogen in urine, it can mean your liver isn't working correctly.

    Too much urobilinogen in urine can indicate a liver disease such as hepatitis or cirrhosis.

    Other names: urine test; urine analysis; UA, chemical urinalysis

    A urobilinogen test may part of a urinalysis, a test that measures different cells, chemicals, and other substances in your urine. A urinalysis is often part of a routine exam.

    Your health care provider may have ordered this test as part of your regular checkup, to monitor an existing liver condition, or if you have symptoms of a liver disease. These include:

    Your health care provider will need to collect a sample of your urine. He or she will provide you with special instructions to ensure the sample is sterile. These instructions are often called as the “clean catch method.” The clean catch method includes the following steps:

    1. Wash your hands.
    2. Clean your genital area with a cleansing pad given to you by your provider. Men should wipe the tip of their penis. Women should open their labia and clean from front to back.
    3. Start to urinate into the toilet.
    4. Move the collection container under your urine stream.
    5. Collect at least an ounce or two of urine into the container, which should have markings to indicate the amounts.
    6. Finish urinating into the toilet.
    7. Return the sample container as instructed by your health care provider.

    You don't need any special preparations. If your health care provider has ordered other urine or blood tests, you may need to fast (not eat or drink) for several hours before the test. Your health care provider will let you know if there are any special instructions to follow.

    There is no known risk to having this test.

    If your test results show too little or no urobilinogen in your urine, it may indicate:

    • A blockage in the structures that carry bile from your liver
    • A blockage in the blood flow of the liver
    • A problem with liver function

    If your test results show a higher-than-normal level of urobilinogen, it may indicate:

    • Hepatitis
    • Cirrhosis
    • Liver damage due to drugs
    • Hemolytic anemia, a condition in which red blood cells are destroyed before they can be replaced. This leaves the body without enough healthy red blood cells

    If your results are abnormal, it does not necessarily indicate you have a medical condition requiring treatment. Be sure to tell your health care provider about any medicines and supplements you are taking, as these can affect your results. If you are a woman, you should tell your health care provider if you are menstruating.

    This test is only one measure of liver function. If your health care provider thinks you might have a liver disease, additional urine and blood tests may be ordered.

    1. Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Bilirubin (Serum); p. 86–87.
    2. Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Fecal Urobilinogen; p. 295.
    3. LabCE [Internet]. Lab CE; c2001–2017. Clinical Significance of Urobilinogen in Urine; [cited 2017 Mar 1]; [about 2 screens]. Available from: https://www.labce.com/spg506382_clinical_significance_of_urobilinogen_in_urine.aspx
    4. Lab Tests Online [Internet]. American Association for Clinical Chemistry; c2001–2017. Urinalysis: At a Glance; [updated 2016 May 26; cited 2017 Mar 1]; [about 2 screens]. Available from: https://labtestsonline.org/understanding/analytes/urinalysis/tab/glance/
    5. Lab Tests Online [Internet]. American Association for Clinical Chemistry; c2001–2017. Urinalysis: The Test; [updated 2016 May 26; cited 2017 Mar 1]; [about 4 screens]. Available from: https://labtestsonline.org/understanding/analytes/urinalysis/tab/test
    6. Lab Tests Online [Internet]. American Association for Clinical Chemistry; c2001–2017. Urinalysis: The Test Sample; [updated 2016 May 26; cited 2017 Mar 1]; [about 3 screens]. Available from: https://labtestsonline.org/understanding/analytes/urinalysis/tab/sample
    7. Lab Tests Online [Internet]. American Association for Clinical Chemistry; c2001–2017. Urinalysis: The Three Types of Exams; [cited 2017 Mar 1]; [about 5 screens]. Available from: https://labtestsonline.org/understanding/analytes/urinalysis/ui-exams?start=1
    8. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co., Inc.; c2017. Urinalysis; [cited 2017 Mar 1]; [about 2 screens]. Available from: https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/diagnosis-of-kidney-and-urinary-tract-disorders/urinalysis
    9. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2017. Bilirubin test; Definition; 2015 Oct 13 [cited 2017 Mar 1]; [about 2 screens]. Available from: http://www.mayoclinic.org/tests-procedures/bilirubin/basics/definition/prc-20019986
    10. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2017. Liver disease: Symptoms; 2014 July 15 [cited 2017 Mar 1]; [about 3 screens]. Available from: http://www.mayoclinic.org/diseases-conditions/liver-problems/basics/symptoms/con-20025300
    11. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2017. Urinalysis: How you prepare; 2016 Oct 19 [cited 2017 Mar 1]; [about 4 screens]. Available from: http://www.mayoclinic.org/tests-procedures/urinalysis/details/how-you-prepare/ppc-20255388
    12. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2017. Urinalysis: What you can expect; 2016 Oct 19 [cited 2017 Mar 1]; [about 5 screens]. Available from: http://www.mayoclinic.org/tests-procedures/urinalysis/details/what-you-can-expect/rec-20255393
    13. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; What is Hemolytic Anemia?; [updated 2014 Mar 21; cited 2017 Mar 1]; [about 3 screens]. Available from: https://www.nhlbi.nih.gov/health/health-topics/topics/ha
    14. National Institute of Diabetes and Digestive and Kidney Diseases [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Liver Disease; [cited 2017 Mar 1]; [about 3 screens]. Available from: https://www.niddk.nih.gov/health-information/liver-disease
    15. Saint Francis Health System [Internet]. Tulsa (OK): Saint Francis Health System; c2016. Patient Information: Collecting a Clean Catch Urine Sample; [cited 2017 May 2 ]; [about 3 screens]. Available from: https://www.saintfrancis.com/lab/Documents/Collecting%20a%20Clean%20Catch%20Urine.pdf
    16. Thapa BR, Walia A. Liver Function Tests and their Interpretation. Indian J Pediatr [Internet]. 2007 July [cited 2017 May 2]; 74 (7) 663–71. Available from: http://medind.nic.in/icb/t07/i7/icbt07i7p663.pdf

    Source: https://medlineplus.gov/lab-tests/urobilinogen-in-urine/

    Urinalysis: A Comprehensive Review

    Urobilinogen in Urine: Low & High Levels + Normal Range

    1. Lifshitz E, Kramer L. Outpatient urine culture: does collection technique matter?. Arch Intern Med. 2000;160:2537–40….

    2. Rabinovitch A. Urinalysis and collection, transportation, and preservation of urine specimens: approved guideline. 2d ed. Wayne, Pa.: National Committee for Clinical Laboratory Standards, 2001. NCCLS document GP16-A2.

    3. Hanno PM, Wein AJ, Malkowicz SB. Clinical manual of urology. 3d ed. New York: McGraw-Hill, 2001.

    4. Woolhandler S, Pels RJ, Bor DH, Himmelstein DU, Lawrence RS. Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders. I. Hematuria and proteinuria. JAMA. 1989;262:1214–9.

    5. Agarwal R, Panesar A, Lewis RR. Dipstick proteinuria: can it guide hypertension management?. Am J Kidney Dis. 2002;39:1190–5.

    6. Pels RJ, Bor DH, Woolhandler S, Himmelstein DU, Lawrence RS. Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders. II. Bacteriuria. JAMA. 1989;262:1221–4.

    7. Sultana RV, Zalstein S, Cameron P, Campbell D. Dipstick urinalysis and the accuracy of the clinical diagnosis of urinary tract infection. J Emerg Med. 2001;20:13–9.

    8. Smith P, Morris A, Reller LB. Predicting urine culture results by dipstick testing and phase contrast microscopy. Pathology. 2003;35:161–5.

    9. Van Nostrand JD, Junkins AD, Bartholdi RK. Poor predictive ability of urinalysis and microscopic examination to detect urinary tract infection. Am J Clin Pathol. 2000;113:709–13.

    10. Eidelman Y, Raveh D, Yinnon AM, Ballin J, Rudensky B, Gottehrer NP. Reagent strip diagnosis of UTI in a high-risk population. Am J Emerg Med. 2002;20:112–3.

    11. Lammers RL, Gibson S, Kovacs D, Sears W, Strachan G. Comparison of test characteristics of urine dipstick and urinalysis at various test cutoff points. Ann Emerg Med. 2001;38:505–12.

    12. Semeniuk H, Church D. Evaluation of the leukocyte esterase and nitrite urine dipstick screening tests for detection of bacteriuria in women with suspected uncomplicated urinary tract infections. J Clin Microbiol. 1999;37:3051–2.

    13. Leman P. Validity of urinalysis and microscopy for detecting urinary tract infection in the emergency department. Eur J Emerg Med. 2002;9:141–7.

    14. Kavouras SA. Assessing hydration status. Curr Opin Clin Nutr Metab Care. 2002;5:519–24.

    15. Sheets C, Lyman JL. Urinalysis. Emerg Med Clin North Am. 1986;4:263–80.

    16. Kiel DP, Moskowitz MA. The urinalysis: a critical appraisal. Med Clin North Am. 1987;71:607–24.

    17. Benejam R, Narayana AS. Urinalysis: the physician’s responsibility. Am Fam Physician. 1985;31:103–11.

    18. Mariani AJ, Mariani MC, Macchioni C, Stams UK, Hariharan A, Moriera A. The significance of adult hematuria: 1,000 hematuria evaluations including a risk-benefit and cost-effectiveness analysis. J Urol. 1989;141:350–5.

    19. Grossfeld GD, Litwin MS, Wolf JS, Hricak H, Shuler CL, Agerter DC, et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy—part I: definition, detection, prevalence, and etiology. Urology. 2001;57:599–603.

    20. Grossfeld GD, Litwin MS, Wolf JS Jr, Hricak H, Shuler CL, Agerter DC, et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy—part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology. 2001;57:604–10.

    21. Ahmed Z, Lee J. Asymptomatic urinary abnormalities. Hematuria and proteinuria. Med Clin North Am. 1997;81:641–52.

    22. Fassett RG, Horgan BA, Mathew TH. Detection of glomerular bleeding by phase-contrast microscopy. Lancet. 1982;1:1432–4.

    23. Brendler, CB. Evaluation of the urologic patient: history, physical examination and urinalysis. In: Campbell MF, Walsh PC. Campbell’s Urology. 7th ed. Philadelphia: Saunders, 1998:144–56.

    24. Sutton JM. Evaluation of hematuria in adults. JAMA. 1990;263:2475–80.

    25. Mohr DN, Offord KP, Owen RA, Melton LJ 3d. Asymptomatic micro-hematuria and urologic disease. A population-based study. JAMA. 1986;256:224–9.

    26. Khan MA, Shaw G, Paris AM. Is microscopic haematuria a urological emergency?. BJU Int. 2002;90:355–7.

    27. Mohr DN, Offord KP, Melton LJ 3d. Isolated asymptomatic microhematuria: a cross-sectional analysis of test-positive and test-negative patients. J Gen Intern Med. 1987;2:318–24.

    28. Messing EM, Young TB, Hunt VB, Emoto SE, Wehbie JM. The significance of asymptomatic microhematuria in men 50 or more years old: findings of a home screening study using urinary dipsticks. J Urol. 1987;137:919–22.

    29. Khadra MH, Pickard RS, Charlton M, Powell PH, Neal DE. A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. J Urol. 2000;163:524–7.

    30. Siegel AJ, Hennekens CH, Solomon HS, Van Boeckel B. Exercise-related hematuria. Findings in a group of marathon runners. JAMA. 1979;241:391–2.

    31. House AA, Cattran DC. Nephrology: 2. Evaluation of asymptomatic hematuria and proteinuria in adult primary care. CMAJ. 2002;166:348–53.

    32. Carroll MF, Temte JL. Proteinuria in adults: a diagnostic approach. Am Fam Physician. 2000;62:1333–40.

    33. Von Bonsdorff M, Koskenvuo K, Salmi HA, Pasternack A. Prevalence and causes of proteinuria in 20-year old Finnish men. Scand J Urol Nephrol. 1981;15:285–90.

    34. Springberg PD, Garrett LE Jr, Thompson AL Jr, Collins NF, Lordon RE, Robinson RR. Fixed and reproducible orthostatic proteinuria: results of a 20-year follow-up study. Ann Intern Med. 1982;97:516–9.

    35. Rytand DA, Spreiter S. Prognosis in postural (orthostatic) proteinuria: forty to fifty-year follow-up of six patients after diagnosis by Thomas Addis. N Engl J Med. 1981;305:618–21.

    36. Gallagher EJ, Schwartz E, Weinstein RS. Performance characteristics of urine dipsticks stored in open containers. Am J Emerg Med. 1990;8:121–3.

    37. Fogazzi GB, Garigali G. The clinical art and science of urine microscopy. Curr Opin Nephrol Hypertens. 2003;12:625–32.

    38. Graham JC, Galloway A. ACP best practice no. 167: the laboratory diagnosis of urinary tract infection. J Clin Pathol. 2001;54:911–9.

    Source: https://www.aafp.org/afp/2005/0315/p1153.html

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