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Kidney

Bilirubin in urine: a blocked bile duct, tumours and the symptoms a review names

Bilirubin is a bile pigment formed during the breakdown of red blood cells; the liver converts it into a water-soluble form, conjugated bilirubin, which normally leaves the body through the bowel and the stool.

According to a 2017 review, a blockage outside the liver can make the conjugated bilirubin in the blood rise, and that form can reach the urine. Only a urine test shows whether there is bilirubin in the urine.

Urine bilirubin is a result without a unit, negative or positive: Unilabs gives 'n.aant.' (not detectable) as the expected result, but reports that the test can no longer be ordered.

Doctor's Assessment Included

Bilirubin is a bile pigment from the breakdown of red blood cells, which the liver converts and removes through the bowel and the stool. Urine should contain no detectable bilirubin: the expected result is negative.

  • Only conjugated bilirubin, the form converted by the liver, dissolves in water and can reach the urine.
  • According to a 2022 review, a positive urine bilirubin result is a reason to investigate the liver and bile ducts.
  • According to the NVKC, the urine bilirubin strip is of limited value: tests in blood are more sensitive and more specific.

Reference Ranges

Expected result Negative

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Urine Bilirubin: what this test measures

A urine bilirubin test uses a test stick to determine whether conjugated bilirubin is in a urine sample, without giving an amount. According to a 2022 review, a positive result points to conjugated bilirubin, because only that form can be excreted in the urine.

Urine Bilirubin: why this value matters

Urine bilirubin matters because it can point to a blockage of the bile ducts, and the NVKC names gallstones, bile duct tumours and pancreatic cancer among the causes of a raised bilirubin in blood. According to a 2022 review, a positive strip is a reason to investigate the liver and bile ducts further.

Urine Bilirubin: how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Urine Bilirubin: when is testing worthwhile?

Star-SHL determines urine bilirubin as part of its urine strip, in a sample that is preferably morning urine. According to the NVKC, a doctor usually orders bilirubin in blood together with other liver function tests when there are signs of liver problems.

Urine Bilirubin: symptoms of a high or low value

Low Levels

A negative bilirubin strip is the normal result; according to a 2022 review, selenium, vitamin C and urine exposed to light for a long time can hide a true positive result.

High Levels

A positive bilirubin strip can fit a blockage of the bile ducts; according to a 2017 review, people with such a blockage can have fever, itching, abdominal pain, weight loss, muscle wasting, dark urine and pale stools, among other things.

Urine Bilirubin: causes of a low or high value

What lowers the value

  • Vitamin C (false negative)

    According to a 2022 review, vitamin C can make a bilirubin strip falsely negative.

  • Urine left in the light (false negative)

    According to a 2022 review, prolonged exposure of the urine to light can give a falsely negative bilirubin strip.

  • Selenium (false negative)

    Selenium is listed in a 2022 review among the causes of a falsely negative bilirubin strip.

What raises the value

  • Liver disease

    Only conjugated bilirubin, the form converted by the liver, can reach urine; a 2022 review names liver disease for a positive strip and advises investigation of the liver and bile ducts.

  • Blocked bile ducts

    A blockage of the bile ducts is in the table of a 2022 review as a possible diagnosis for a positive bilirubin strip.

  • Phenazopyridine (false positive)

    According to a 2022 review, the medicine phenazopyridine can give a falsely positive bilirubin strip.

Urine Bilirubin: lifestyle and this value

With a positive bilirubin strip, according to the NVKC there are better tests in blood, more sensitive and more specific than the strip. For the initial laboratory evaluation of jaundice in adults, a 2017 review names fractionated bilirubin, a complete blood count, ALT, AST, alkaline phosphatase and gamma-GT, among others.

Urine Bilirubin: frequently asked questions

Can pancreatic cancer cause bilirubin in the urine?

Pancreatic cancer is on the NVKC's list of causes of a raised bilirubin in blood, and a 2017 review names a tumour that blocks the bile ducts as a cause of raised conjugated bilirubin, the form that can reach urine.

What are the signs of a blocked bile duct?

According to a 2017 review, a blocked bile duct can cause fever, itching, abdominal pain, weight loss, muscle wasting, dark urine and pale stools, among other things.

Does Unilabs measure urine bilirubin?

No, Unilabs reports that the separate urine bilirubin test can no longer be ordered, and its current urine strip does not include bilirubin.

Urine Bilirubin: sources

  1. Hitzeman N, Greer D, Carpio E. Office-Based Urinalysis: A Comprehensive Review. Am Fam Physician 2022;106(1):27-35B. (retrieved 2026) aafp.org

Tests with related values

These panels measure values from the same category as this marker.

Heart and blood vessels

Complete Metabolic Panel

Comprehensive metabolic panel: electrolytes, kidney, liver, glucose, HbA1c, and protein.

HbA1c (Glycated Hemoglobin) ALT (Alanine Aminotransferase) Calcium ALP (Alkaline Phosphatase) AST (Aspartate Aminotransferase) Bilirubin (Total) Urea (BUN) Creatinine eGFR (Estimated Glomerular Filtration Rate) Glucose (Fasting) Bicarbonate Chloride Sodium Potassium Albumin Total Protein Bilirubin (Direct) Bilirubin (Indirect)
€149,-
Testosterone

Complete Men's Health Panel

A broad men's health panel: hormones, heart, metabolic, and organ function in one blood draw.

HbA1c (Glycated Hemoglobin) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) Triglycerides Creatinine Glucose (Fasting) Free T4 (Thyroxine) LDL Cholesterol SHBG (Sex Hormone Binding Globulin) Total Cholesterol Vitamin D (25-OH) Free Testosterone Total Testosterone Ferritin hs-CRP (High Sensitivity CRP) HDL Cholesterol eGFR (Estimated Glomerular Filtration Rate) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€289,-
Prostate

Men Over 40 Panel

Age-appropriate screening including testosterone and PSA.

HbA1c (Glycated Hemoglobin) PSA (Prostate-Specific Antigen) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) Triglycerides Creatinine Free T4 (Thyroxine) LDL Cholesterol SHBG (Sex Hormone Binding Globulin) Total Cholesterol Vitamin D (25-OH) Free Testosterone Total Testosterone hs-CRP (High Sensitivity CRP) HDL Cholesterol eGFR (Estimated Glomerular Filtration Rate) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€279,-

Medical reviewer

Medical standards

Dr. Naimi oversees the medical standards behind our content and assessments.

Medical policy
CIBG Ministerie van Volksgezondheid,
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