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Bilirubin is not normally present in urine — its detection on a urinalysis dipstick indicates liver disease, bile duct obstruction, or a haemolytic process causing direct bilirubin to spill into urine. The finding is often the first clue to hepatitis, cholestasis, or gallstones in an otherwise asymptomatic individual. Urine bilirubin is less sensitive than serum bilirubin but more convenient as an initial screen, and a positive result always warrants a confirmatory serum liver panel.
Positive urine bilirubin indicates elevated conjugated bilirubin from biliary obstruction or hepatocellular disease. Negative is expected and any bilirubin is abnormal.
Optimal is negative. Urine bilirubin can be positive before clinical jaundice is visible.