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Kidney

Bilirubin in urine: gallstones, the bile duct and what the urine strip does and does not see

According to the NVKC, bilirubin is a breakdown product of haemoglobin, the protein from red blood cells, and the liver converts it into conjugated bilirubin, which leaves the body through the bowel and the stool. Gallstones and tumours of the bile ducts are on the NVKC's list of causes of a raised bilirubin in blood.

With a blockage of the bile ducts, the converted bilirubin in the blood can increase, and because that form dissolves in water, it can end up in the urine. Only a urine test shows whether that is the case.

Urine bilirubin is reported as negative or positive, without a unit, and Star-SHL expects 'Negatief' (negative).

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 strip responds only to conjugated bilirubin, the form the liver has already converted. According to a 2005 review, unconjugated bilirubin cannot pass through the glomeruli, the filters of the kidney, and so does not reach the urine.

Urine Bilirubin: why this value matters

Urine bilirubin matters with a bile duct problem, because a 2022 review names a blockage of the bile ducts as a possible diagnosis for a positive strip. According to a 2017 review, a gallstone in the main bile duct (choledocholithiasis) is the most common cause of bile duct blockage that is not a tumour, accounting for 14% of all new cases of jaundice in adults.

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?

Urine bilirubin is determined with a urine strip, at Star-SHL preferably in morning urine. According to the NVKC, with signs of liver problems the doctor usually has bilirubin in blood determined, such as with a yellow skin or yellow whites of the eyes: signs of jaundice from abnormalities in the liver or the bile drainage.

Urine Bilirubin: symptoms of a high or low value

Low Levels

A negative urine bilirubin result is the expected result. With disorders in which red blood cells are destroyed (haemolysis) and with Gilbert syndrome, according to a 2017 review, the unconjugated bilirubin rises, the form that according to a 2005 review does not dissolve in water and does not pass the kidney filters.

High Levels

A positive urine bilirubin result can, with a blocked bile duct, go together with dark urine and pale stools, two of the signs a 2017 review names for bile duct blockage, besides fever, itching and abdominal pain, among others.

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 urine bilirubin result, blood tests give a better picture according to the NVKC, because they are more sensitive and more specific than the strip. According to a 2022 review, vitamin C in the urine can make the strip falsely negative.

Urine Bilirubin: frequently asked questions

Can gallstones cause bilirubin in the urine?

Gallstones can cause bilirubin in the urine when a stone blocks the main bile duct: a 2017 review names that blockage as a cause of raised conjugated bilirubin, the form that can end up in urine.

What is jaundice?

According to the NVKC, jaundice is a yellow skin or yellow whites of the eyes from an increased amount of bilirubin due to abnormalities in the liver or the bile drainage.

What can give a falsely positive bilirubin strip?

According to reviews from 2005 and 2022, a falsely positive bilirubin strip can come from the medicine phenazopyridine.

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

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Tests with related values

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

Metabolism

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)
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