An elevated urine urobilinogen with a negative urine bilirubin result may indicate which condition?

An elevated urine urobilinogen with a negative urine bilirubin result may indicate which condition?

• A. Hepatic disease
• B. Hemolytic disease
• C. Cholestasis
• D. Kidney disease

Answer: (B)

When urine shows more urobilinogen but no bilirubin, it points to increased production of bilirubin with normal conjugation and bile flow, as seen in hemolytic disease. Destruction of red cells raises bilirubin production; the liver conjugates much of this bilirubin and excretes it into the intestine, where gut bacteria convert it to urobilinogen. Some of that urobilinogen is reabsorbed and cleared by the kidneys, elevating urinary urobilinogen. Because the bilirubin being produced is mainly unconjugated and not water-soluble, it is not excreted in the urine, so urine bilirubin remains negative. In hepatic disease or cholestasis, bilirubin in urine is more likely to be present or the urobilinogen pattern would differ, and kidney disease does not typically produce this combination.

When urine shows more urobilinogen but no bilirubin, it points to increased production of bilirubin with normal conjugation and bile flow, as seen in hemolytic disease. Destruction of red cells raises bilirubin production; the liver conjugates much of this bilirubin and excretes it into the intestine, where gut bacteria convert it to urobilinogen. Some of that urobilinogen is reabsorbed and cleared by the kidneys, elevating urinary urobilinogen. Because the bilirubin being produced is mainly unconjugated and not water-soluble, it is not excreted in the urine, so urine bilirubin remains negative. In hepatic disease or cholestasis, bilirubin in urine is more likely to be present or the urobilinogen pattern would differ, and kidney disease does not typically produce this combination.