Urobilinogen (mesobilirubinogen) is a product of bilirubin reduction. The latter is a bile pigment formed during the breakdown of proteins containing hemes.
Thus, urobilinogens arise from the disposal of red blood cells. Urobilinogen is formed in the intestines from bilirubin, which gets there along with bile. Under the influence of enzymes and microorganisms, it is oxidized and absorbed back into the blood. After this, it enters the kidneys and is excreted in the urine.
If urobilinogen in the urine is increased and its concentration exceeds 10 mg/ml, we speak of hyperurobilinogenuria. This condition may be a consequence of a violation of the reuptake of urobilinogen by hepatocytes, an increase in the synthesis of precursors of urobilinogen bodies - bilirubin, as well as an increase in the level of its absorption in the intestine. We will look at what this means in this article 34.
Urobilinogen, what is it?
The synthesis of uro begins in the blood. There, red blood cells break down, hemoglobin passes to the liver and turns into bilirubin. It enters the intestine and is converted to urobilinoids in the urine.
Total urobilinogen is colorless. It is divided into two types:
- urobilinogen, which is produced in the bladder;
- stercobilinogen, synthesized in the intestine (forms stercobilin, which colors feces).
An increase in the ubg indicator in a person in a urine test occurs due to intravascular disorders that cause hemolysis (disintegration) of red blood cells, since they begin the synthesis of urobilinogen. If liver disease occurs, for example hepatitis, cirrhosis, the cycle of pigment formation is disrupted, which leads to the fact that sterco and urobilin are not formed, and only urobilinoids in urine analysis increase.
Biochemistry and microbiology with microscopy
Now let's talk about the biochemical properties of urine and what it means. If you are deciphering a general urine test in adults, a table that includes standard indicators characteristic of this liquid will be of good help. Usually, increased attention is paid to protein, sugars and bilirubin when considering them. These three indicators are practically absent in the norm.
Protein may be contained in very small quantities, not exceeding 0.033 g/l. If its amount is higher, we can talk about the presence of kidney diseases. Sugars in urine are also mostly absent; in extreme cases, the amount should not exceed 0.9 mmol/l. If this condition is not met, the cause may be the development of diabetes mellitus. And finally, bilirubin, which normally should also be absent. Otherwise, this indicator indicates impaired liver functionality.
General clinical urinalysis (OAM)
A general urinalysis (UCA) is a test that every person must undergo annually during the diagnosis of the body. It gives the doctor a general idea of the condition of the urinary system in adults and children. If any indicator is violated, the therapist prescribes additional studies to recognize the disease.
Preparation for analysis of adults (men, women, pregnant women)
TAM shows the amount of urobilinogen. But in order for the laboratory technician to identify the true value, the person must adhere to the rules of preparation for testing.
- A week before the study, you should not use any medication, since almost all of them enter the blood. If this cannot be done for health reasons, the patient warns the doctor about this.
- A few days before the planned analysis, stick to a diet, do not eat fatty, fried, spicy, salty foods. Drink enough water. Don't drink alcohol.
- Urine for testing is collected immediately after sleep; you should not eat before, as food will affect many indicators of OAM.
- To collect biological fluid, sterile containers are used that are designed specifically for this purpose. The use of homemade jars is prohibited; they contain foreign substances and microorganisms that will change the test result.
- Before urinating, wash the external genitalia with bactericidal soap.
- Women (especially pregnant women) need to cover the vagina with a cotton swab before urinating. Otherwise, bacteria from it will get inside the sample.
- For OAM, collect all the urine inside a large container, mix it and pour 10-15 ml into a special container.
- The sample is delivered to the laboratory immediately, so the indicators will be the most informative. If this is not possible, the biomaterial is stored inside the refrigerator for no more than 3 hours. If the time is extended, biochemical reactions will occur that will change the result of the analysis.
- The patient's name and collection time are written on the container.
Analysis rate for adults
Urobilinogen is excreted by the intestines and urinary system. The smallest part comes out through the urine (traces are formed in the urine), therefore a change in the uro indicator in the urine is noticeable in OAM. The norm for adult women and men is considered to be 5 mg ubg per 1 liter of urine.
In pregnant women, the rate increases sharply; this is considered a variant of the norm. The value reaches 36 mg/l.
Important! Both an increase and a decrease are considered a sign of the presence of a disease. If uro deviates from the norm, you need to consult a doctor so that he can decipher the data, explain what the urobilinogen pigment is, explain the reason for the change in the indicator and prescribe treatment.
Organoleptic studies and physicochemical properties
Organoleptic studies mean an assessment of the condition of urine, which is based on the appearance of the liquid. This method does not require the use of additional devices.
- Smell. Normally, it has a certain specificity, but there are no foreign inclusions. We can talk about pathology when an admixture of rot, ammonia or feces appears. It should be taken into account that the smell cannot be assessed objectively; accordingly, many laboratories exclude this point of research.
- Color. Typically, urine is yellow in color with shades ranging from straw to amber. Their intensity depends on the amount of bile pigments formed as a result of the breakdown of hemoglobin. In the presence of a number of diseases and under the influence of various factors (not always pathological), urine can darken or become lighter, also changing color - sometimes to the most unusual shades.
- Transparency. In the absence of pathologies, the normal state of urine is complete transparency. In cases where sediment, flakes or other foreign matter is observed in the urine, tests that determine the presence of the substance are mandatory.
- Foam. To consider this indicator, shake a test tube with liquid; if everything is in order with health, the foam disappears quite quickly. If it is resistant, the reason may be the presence of protein, and the presence of a yellow color indicates liver disease and jaundice.
In addition, when conducting research, one should take into account diuresis per day, data on which is provided by the patient. Normally, the volume of urine produced should be equal to ¾ of the liquid drunk within 24 hours, which is approximately two liters.
When considering the physical and chemical properties, increased attention is paid to the relative density (SG) and acid-base reaction of the liquid. In the first case, in adults the norm of specific gravity is from 1010 to 1022 units; in children, the values should fall in the range of 1007-1021. Density values depend on additional components - protein, salt, glucose, and various foreign microorganisms. As the number of these components increases, the density of urine also increases. A urometer is used to determine specific gravity.
Acidity (pH) in the normal state should be slightly acidic, amounting to 5-7 units. This indicator largely depends not only on the presence of pathologies, but also on the daily menu.
What does urobilinuria mean?
Urobilinuria is a urine condition in which urobilinogen is increased. Not every increase indicates the presence of pathology. Minor fluctuations within 2 units are considered normal for urobilinoids; there is no need to worry about this. Urobilinuria appears when the physiological functions of the body or environmental conditions change. If the indicator exceeds 11 mg/l, you need to consult a doctor and conduct additional examinations to evaluate internal organs and systems.
Non-pathological causes
A physiological factor includes a change in the body’s water balance. The less fluid a person consumes, the more concentrated the urine becomes. This means that the amount of fluid released through the blood to the kidneys decreases, and the concentration of urine substances increases. When the drinking regime is restored, the test results will show the normal uro level in a urine test if the person is healthy.
As the ambient temperature increases, a person begins to sweat heavily. Excessive fluid is released from the body. The concentration of ubg increases as there is less excretory fluid.
Another option for a normal increase is pregnancy. This period is characterized by changes in many indicators of the body; this does not necessarily mean illness. The level of urobilinogen in urine increases.
Diseases of the liver, gastrointestinal tract
If the study reveals an increase in ubg, the first thing the therapist will suspect is liver disease. Having ordered additional studies (ultrasound of the abdominal cavity, X-ray, OBC, MRI, CT), the doctor will diagnose the patient. Liver diseases causing an increase in uro:
- hepatitis (viral, infectious, drug-induced, alcoholic);
- cirrhosis (alcoholic, due to hepatitis or heart failure);
- fatty hepatosis.
In these diseases, in the later stages, characteristic symptoms of inflammation of the organ parenchyma appear:
- jaundice;
- subfibrility (increase in body temperature to 37-37.5 degrees, fever);
- spider veins on the skin;
- dryness, peeling of the skin.
For the normal functioning of the gastrointestinal tract, it is necessary that bile is secreted, which is involved in digestion. If its duct is blocked (by a polyp, stone, tumor), pressure increases inside the organ. This causes a disruption in the synthesis and transformation of bile pigments. Bilirubin appears in the blood and urine, and the concentration of ubg urine increases. Urine becomes dark in color (color, like beer), feces become lighter, since stercobilin is absent.
Such changes cause the following conditions and diseases:
- benign and malignant neoplasms;
- cysts, outgrowths, diverticula of the bile duct;
- organ compression;
- postoperative scars.
Inflammation of the intestinal mucosa and its changes form urobilinuria. The following gastrointestinal diseases lead to this:
- enteritis, colitis;
- intestinal obstruction;
- poisoning and intoxication;
- constipation that lasts a long time;
- presence of intestinal helminths.
Pathologies in pregnant women
During pregnancy, almost all indicators of blood and urine tests change. After fertilization of the egg and its attachment to the uterus, a restructuring of the hormonal functions of the body occurs. This leads to the water-salt balance changing. Some pregnant women begin to sweat excessively. There is less blood plasma, the specific density of urine increases. That is, there is less urine fluid, but the concentration of substances remains the same or increases. Therefore, analysis of excretory fluid shows urobilinuria.
Over time, the fruit increases in size. It compresses the internal organs. If pressure is applied to the gallbladder duct, urobiluria begins. Urine darkens. If such a condition is detected, the doctor prescribes drugs that help improve bile secretion and relieve inflammation in the organ. After the birth of a child, the woman’s body is restored, the uro indicator returns to normal.
If a pregnant woman drinks a normal amount of water and the bile duct is not compressed, the doctor will suspect the presence of a disease. He will prescribe additional research methods. After identifying the pathology, drugs are used that will not harm the child.
Other pathologies
The synthesis and transformation of hemoglobin into other pigments is influenced by many organs and systems. Defeat of any of them can lead to urobilinuria.
Red blood cell hemolysis is a condition in which increased destruction of red blood cells occurs. The more hemoglobin is released during this process, the more ubg is released into the urine.
Diseases of the spleen. This organ disposes of destroyed red blood cells along with the liver. If this does not happen, urobilinuria occurs.
When food poisoning occurs, vomiting and diarrhea occur. This leads to a decrease in body fluid, which causes a temporary increase in the levels of various TAM substances. If poisoning occurs with poisons or toxic substances, liver damage occurs. This leads to the organ becoming inflamed and persistent urobilinuria is formed.
Deviations
Reasons for the increase in children and adults
The reason why urobilinogen in the urine is increased may be red blood cells. Red bodies cause intestinal dysfunction in the following cases:
- physical injury;
- anemia (excessive destruction of red blood cells);
- viral hepatitis;
- hepatitis intoxication (drugs or alcohol);
- liver cancer and cirrhosis;
- liver tumors (benign/malignant);
- stagnation in liver tissues;
- chemical poisoning;
- the presence of parasites in the intestines;
- severe stress on the liver;
- chronic constipation.
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Causes of low levels of urobilinogen in urine
Reasons for low urobilinogen (less than I) in human urine:
- change in bacterial flora;
- cholestasis of the biliary tract;
- enzyme deficiency (glucuronyl transferase).
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Treatment
There is no cure for urobilinuria. They treat the disease that caused it. Therefore, the drugs chosen by the doctor depend on the patient’s illness. If the condition has caused a temporary physiological change, the therapist will prescribe a diet and plenty of fluids.
- The diet excludes fatty, fried, spicy foods. Products are steamed. Alcohol should not be consumed.
- Hepatoprotectors. Prescribed for liver diseases.
- Choleretic. Prescribed when inflammation of the gallbladder is detected. If the duct is blocked (by a stone, a polyp), surgical intervention is used.
- Iron supplements. Prescribed after detection of anemia.
- Anti-inflammatory drugs.
- Sorbents. Used if poisoning occurs.
- Antihelminthics are prescribed if the stool test is positive for worm eggs.
Correction of indicators
To normalize liver functions and reduce pathological levels of urobilin, a number of drugs with targeted action are used:
- essential phospholipid hepatoprotectors (Essliver, Gepagard, Phosphogliv, Eslidin, Enerliv, Phosphonciale, Essentiale Forte N);
- plant-based hepatoprotective agents (Liv-52, Bonjigar, Silimar/Karsil, Diapana, Galstena, Cyrinax);
- hepatoprotectors-lipotropics (Heptral, Hepa-Merz, Betargin);
- Dietary supplements and vitamin complexes for the liver (Tiogamma, Berlition 300, Thiolepta, Lipothioxone, lipoic acid, Thiolipon);
- bile acids of synthetic origin: Ursosan and analogues of the drug.
All medications must be prescribed by a doctor.
Prevention
In order for bile pigments to be within normal values, it is necessary to drink as much water as possible per day, adhere to proper nutrition and a healthy lifestyle. The expiration date on products should be checked to avoid poisoning. After the onset of cold weather, dress according to the weather so that your kidneys do not become inflamed. To prevent damage to liver hepatocytes, alcohol consumption is not recommended.
If darkening of urine is observed for a long time, you should take an OAM. If an increased uro appears in it, consult a doctor. A timely diagnosis and proper treatment contribute to a positive prognosis of the disease.
