From the Research
Elevated urobilinogen in urine is a significant indicator of acute hepatic porphyria, particularly when the urinary urobilinogen/serum total bilirubin ratio is elevated, as evidenced by a recent study 1. This condition suggests either excessive red blood cell destruction or liver disease that impairs the liver's ability to process and recirculate urobilinogen. Other causes of elevated urobilinogen include biliary tract obstruction, infectious mononucleosis, or congestive heart failure. The finding of elevated urobilinogen requires further investigation through additional tests like complete blood count, liver function tests, and possibly imaging studies to determine the underlying cause. Key points to consider in the evaluation of elevated urobilinogen include:
- The urinary urobilinogen/serum total bilirubin ratio can be used as a sensitive and specific screening marker for acute hepatic porphyria in patients with abdominal pain 1.
- Elevated urobilinogen is not diagnostic of a specific condition but serves as an important clinical clue that warrants medical evaluation, especially when accompanied by symptoms like jaundice, dark urine, fatigue, or abdominal pain.
- Other studies have explored the utility of urinary urobilinogen in diagnosing conditions such as biliary atresia, where it has been found to be a simple, non-invasive, and cheap marker, especially when combined with γ-glutamyltransferase (γ-GT) 2. However, the most recent and highest quality study 1 prioritizes the urinary urobilinogen/serum total bilirubin ratio as a critical indicator for acute hepatic porphyria. Therefore, in the context of real-life clinical medicine, elevated urobilinogen in urine should prompt a thorough evaluation for underlying causes, with a particular consideration for acute hepatic porphyria when the urinary urobilinogen/serum total bilirubin ratio is elevated, as supported by the most recent evidence 1.