---
title: "Bilirubin in urine levels: why any positive is abnormal, the liver and bile-duct causes, and what to check next"
type: biomarker
url: "https://www.test-well.com/biomarkers/bilirubin-in-urine"
also_known_as:
  - bilirubin in urine
  - urine bilirubin
  - bilirubin, ua
  - bilirubin, urine
  - bilirubinuria
category: Urinalysis
units:
  - mg/dL
order_price_usd: 17.99
order_item: Complete Urinalysis Test
order_url: "https://www.test-well.com/tests/urinalysis"
reviewed_at: 2026-11-03
---

# Bilirubin in urine levels: why any positive is abnormal, the liver and bile-duct causes, and what to check next

> Bilirubin in Urine is measured with a urine sample; no fasting is needed. At TestWell it's $17.99 all-in as Complete Urinalysis Test, results in 1–3 business days, drawn at Labcorp. An out-of-range result is a prompt to look closer, not a diagnosis.

Bilirubin should never be in the urine. Only the conjugated, water-soluble form made by the liver can pass into it, and in health the liver sends all of that into bile. A positive urine bilirubin — often noticed first as dark, tea-colored urine or a yellow foam — means the liver has processed bilirubin but cannot clear it: hepatitis, a blocked bile duct, drug injury or cirrhosis. It frequently appears before jaundice does, which makes it an early warning worth a prompt liver panel.

Also known as: bilirubin in urine, urine bilirubin, bilirubin, ua, bilirubin, urine, bilirubinuria.

## Key facts

| Fact | Value |
| --- | --- |
| Units | mg/dL |
| Sample | Urine sample |
| Fasting | Not required |
| Results | 1–3 business days |
| Price | $17.99 |
| Labs | Labcorp · BioReference in NY/NJ |

## What does bilirubin in urine measure?

Bilirubin comes from the breakdown of hemoglobin. It circulates bound to albumin in an unconjugated form that cannot pass through the kidney, is taken up by the liver and conjugated with glucuronic acid, and is secreted into bile. Only the conjugated form is water-soluble, and only it can appear in urine — so urine bilirubin is a test of conjugated bilirubin that has leaked back into the blood instead of leaving in bile.

That is why hemolysis, Gilbert's syndrome and the physiological jaundice of newborns — all unconjugated — leave the urine bilirubin negative no matter how yellow the person is, while hepatitis and bile-duct obstruction turn it positive, sometimes days before the skin changes. Dark urine in a jaundiced person is itself a sign that the bilirubin is conjugated.

The dipstick detects roughly 0.5 mg/dL and reports small, moderate and large (1+ to 3+). Bilirubin breaks down to biliverdin in light, so an old or sun-exposed sample reads falsely negative; large doses of vitamin C and a nitrite-positive urine also suppress the reaction, while phenazopyridine, chlorpromazine metabolites and some other colored drugs produce a false positive.

## Who should check bilirubin in urine?

Anyone with dark, tea- or cola-colored urine, pale or clay-colored stools, itching without a rash, yellowing of the eyes or skin, a tender right upper abdomen, or nausea and loss of appetite with fatigue after a viral illness, a new medication or heavy drinking. It is also a useful early check in people with known hepatitis B or C, cirrhosis, gallstones, pancreatic disease, heavy alcohol use, or on drugs known to injure the liver, and in pregnancy when itching and dark urine raise the question of cholestasis of pregnancy (where bile acids are the definitive test).

Most positives are found on a urinalysis ordered for something else, and in that situation the first move is the same as for symptoms: a hepatic function panel the same week.

## How to get tested for bilirubin in urine and prepare

Urine bilirubin is part of a complete urinalysis, which through TestWell is collected as a walk-in urine sample at a Labcorp patient service center (the reflex-to-culture version is also at Quest). Because a positive always leads to blood tests, ordering a hepatic function panel at the same visit — bilirubin total and direct, ALT, AST, alkaline phosphatase, albumin and total protein — saves a second trip.

Give a fresh sample and keep it out of light; bilirubin degrades within hours. Mention phenazopyridine (urinary analgesic), chlorpromazine, rifampin and other urine-coloring drugs, any vitamin C above a gram a day, and all medications and supplements — acetaminophen, antibiotics such as amoxicillin-clavulanate, anabolic steroids, bodybuilding supplements and green-tea extracts are among the common causes of drug-induced liver injury.

## What is a normal bilirubin in urine result?

Negative. There is no normal amount; even a small positive on a fresh sample is abnormal and is confirmed with serum bilirubin, which will show the direct (conjugated) fraction raised. A positive with a normal serum bilirubin can occur early in liver disease, when the kidney clears conjugated bilirubin efficiently, and is still taken seriously.

Interpretation leans on the urobilinogen beside it: bilirubin positive with high urobilinogen is the hepatocellular pattern (hepatitis, cirrhosis); bilirubin positive with low or absent urobilinogen is obstruction (a stone, stricture or tumor blocking the duct), typically with pale stools, itching and a high alkaline phosphatase. A jaundiced person with negative urine bilirubin has an unconjugated problem — hemolysis or Gilbert's — and the work-up goes to the blood count and reticulocytes rather than the bile ducts.

## What causes bilirubin in urine?

Liver cell injury: acute viral hepatitis A, B, C and E, mononucleosis and other viral hepatitides; alcoholic hepatitis; drug- and supplement-induced liver injury (acetaminophen, amoxicillin-clavulanate, isoniazid, anabolic steroids, methotrexate, some herbal and bodybuilding products); autoimmune hepatitis; ischemic hepatitis after shock or heart failure; and cirrhosis of any cause. Bile-duct obstruction: a gallstone in the common bile duct, a stricture, primary sclerosing cholangitis, primary biliary cholangitis, tumors of the pancreatic head, bile duct or ampulla, and external compression. Intrahepatic cholestasis from drugs (estrogens, anabolic steroids, chlorpromazine, antibiotics), pregnancy, sepsis and total parenteral nutrition.

Two inherited conditions cause a raised conjugated bilirubin with an otherwise normal liver — Dubin–Johnson and Rotor syndromes — and are benign. False positives come from phenazopyridine, chlorpromazine, etodolac and strongly pigmented urine; a positive that cannot be reproduced on a fresh sample with a normal serum direct bilirubin was probably one of these.

## What to check next when bilirubin shows in urine

A hepatic function panel the same week: total and direct bilirubin, ALT and AST (which rise most in hepatocellular injury), alkaline phosphatase and GGT (which rise most in obstruction and cholestasis), and albumin and prothrombin time or INR for the liver's synthetic function. Add hepatitis A IgM, hepatitis B surface antigen and core IgM, and hepatitis C antibody when the aminotransferases are high, and a full medication, supplement and alcohol history. An abdominal ultrasound follows promptly when the alkaline phosphatase is raised, the stools are pale or the urobilinogen is low — dilated ducts mean obstruction and a gastroenterology or surgical referral. Fever with jaundice and right-upper-abdominal pain is cholangitis; jaundice with confusion, bleeding or a very high INR is liver failure; both are emergencies.

## What does a high Bilirubin in Urine mean?

Any positive is abnormal and points to the liver or bile ducts: hepatitis, a blocked duct (gallstone, stricture, pancreatic mass), drug-induced liver injury or cirrhosis; it often appears before jaundice and before blood bilirubin is obviously raised.

## How do you get tested for Bilirubin in Urine?

| Order | Type | Price | Includes |
| --- | --- | --- | --- |
| [Urinalysis, Complete](https://www.test-well.com/tests/urinalysis) | Single test | $17.99 | This marker |
| [Kidney Health Panel](https://www.test-well.com/tests/kidney-health-panel) | Panel | $64.99 | 4 tests |
| [Early Pregnancy Panel](https://www.test-well.com/tests/prenatal-screening-panel) | Panel | $249.99 | 9 tests |
| [Men's Total Body Advanced Panel](https://www.test-well.com/tests/mens-total-body-advanced-panel) | Panel | $999.99 | 65 tests |
| [Women's Total Body Advanced Panel](https://www.test-well.com/tests/womens-total-body-advanced-panel) | Panel | $999.99 | 65 tests |

## Quest vs Labcorp vs BioReference

| Lab | Available | Price | Notes |
| --- | --- | --- | --- |
| Quest Diagnostics | No | — | Not offered through Quest for this test. |
| Labcorp | Yes | $17.99 | Choose Labcorp at checkout; walk-in patient service centers in every state TestWell serves outside NY and NJ. |
| BioReference (NY & NJ) | Yes | $20.99 | New York and New Jersey orders route here automatically — state rules keep Quest and Labcorp from accepting self-ordered draws. |

- [What a high Bilirubin in Urine means (causes, symptoms, next steps)](https://www.test-well.com/biomarkers/bilirubin-in-urine/high)

## Common questions about Bilirubin in Urine

### Is bilirubin in urine ever normal?

No. A healthy liver sends all of its conjugated bilirubin into bile, so the urine result should be negative. Any positive on a fresh, properly collected sample is confirmed with serum bilirubin and a liver panel. The one caveat is interference: phenazopyridine and some other colored drugs can mimic a positive, and a repeat without them settles it.

### Why is urine bilirubin negative in Gilbert's syndrome and hemolysis?

Because in both the extra bilirubin is unconjugated, bound to albumin, and cannot pass through the kidney. Only conjugated bilirubin is water-soluble and appears in urine. A yellow-looking person with a negative urine bilirubin therefore has an unconjugated cause — Gilbert's, hemolysis, newborn jaundice — and the investigation turns to a blood count, reticulocytes and the indirect bilirubin rather than the bile ducts.

### Can bilirubin in urine appear before jaundice?

Yes, often. The kidney clears conjugated bilirubin efficiently, so it shows in urine at serum levels below the 2–3 mg/dL at which the eyes and skin turn yellow. Dark, tea-colored urine or a yellow foam when shaken is frequently the first sign of hepatitis or a bile-duct obstruction, which is why a positive is treated as an early warning and not a curiosity.

### What tests follow a positive urine bilirubin?

A hepatic function panel — total and direct bilirubin, ALT, AST, alkaline phosphatase, GGT and albumin — with a prothrombin time, hepatitis serologies if the liver enzymes are raised, a careful drug, supplement and alcohol history, and an abdominal ultrasound when the alkaline phosphatase is high, the stools are pale or the urine urobilinogen is low. Jaundice with fever and abdominal pain, or with confusion or bleeding, needs emergency care.

### Do I need a doctor's order to test my bilirubin in urine?

No. TestWell's licensed physician network reviews and approves your order — usually within minutes. You can place an order online without an in-person visit or a referral from your own doctor.

### How long does it take to get Bilirubin in Urine results?

Most Bilirubin in Urine results are available in 1–3 business days after your specimen arrives at the lab. You'll get an email the moment your results are ready, with everything viewable in your TestWell portal.

### How much does a Bilirubin in Urine test cost?

Our Complete Urinalysis Test starts at $17.99. That's the all-in price — no copays, no insurance hoops, no surprise bills. HSA and FSA cards are accepted.

### Do I need to fast before my Bilirubin in Urine test?

Fasting is not required for the Bilirubin in Urine test. You can have your blood drawn any time of day.

### Which lab will process my Bilirubin in Urine test?

Your test will be processed by Quest Diagnostics, Labcorp, or BioReference depending on which is closest to you and which lab carries the test. All three are CLIA-certified and trusted by hospitals nationwide. You'll choose your lab during checkout from 4,000+ locations.

## Keep reading

- [Liver Function Tests Explained: What a Liver Panel Shows and When to Get One](https://www.test-well.com/guides/liver-function-tests)
- [How Much Does a Liver Function Test (LFT) Cost? Hepatic Panel Prices by Setting, With and Without Insurance](https://www.test-well.com/guides/liver-function-test-cost)
- [How to Read Your Blood Test Results, Line by Line](https://www.test-well.com/guides/how-to-read-your-blood-test-results)
- [Itchy skin without a rash: which blood tests?](https://www.test-well.com/symptoms/itchy-skin)
- [Fatigue: which blood tests?](https://www.test-well.com/symptoms/fatigue)
- [Nausea: which blood tests?](https://www.test-well.com/symptoms/nausea)
- [Before your test: Common medications](https://www.test-well.com/prep/medications)
- [Before your test: Alcohol](https://www.test-well.com/prep/alcohol)
- [Before your test: Vitamins and supplements (when to stop)](https://www.test-well.com/prep/vitamins-and-supplements)

## Sources

- [MedlinePlus (NIH) — Bilirubin in Urine](https://medlineplus.gov/lab-tests/bilirubin-in-urine/)
- [Simerville JA, et al. Urinalysis: a comprehensive review. Am Fam Physician. 2005;71(6):1153–62](https://www.aafp.org/pubs/afp/issues/2005/0315/p1153.html)
- [Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112(1):18–35](https://pubmed.ncbi.nlm.nih.gov/27995906/)
- [NIDDK — Jaundice and cholestasis (LiverTox)](https://www.ncbi.nlm.nih.gov/books/NBK547852/)

## Related biomarkers

- [Protein in Urine](https://www.test-well.com/biomarkers/protein-in-urine)
- [Blood in Urine](https://www.test-well.com/biomarkers/blood-in-urine)
- [Ketones in Urine](https://www.test-well.com/biomarkers/ketones-in-urine)
- [Leukocyte Esterase](https://www.test-well.com/biomarkers/leukocyte-esterase)
- [Urobilinogen](https://www.test-well.com/biomarkers/urobilinogen)
- [Epithelial Cells in Urine](https://www.test-well.com/biomarkers/epithelial-cells-in-urine)

- [Reference range lookup tool](https://www.test-well.com/tools/reference-range-lookup)
- [Lab unit converter](https://www.test-well.com/tools/lab-unit-converter)
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---

Medically reviewed by Youmna DiStefano, MD (Medical Reviewer, TestWell); last reviewed 2026-11-03. Review policy: https://www.test-well.com/reviewers/youmna-distefano-md

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