Objective Hypoalbuminemia is a typical symptom of nephrotic syndrome ( NS) , which may result from the loss of much protein with urine.Hyperbilirubinemia is also a common symptom in patients with NS.This study is intended to reveal the relationship between hypoalbuminemia and hyperbilirubinemia in patients with NS by investigating urine bilirubin, albumin( ALB ) and 24-hour urine protein in the NS group, chronic glomerulonephritis ( CGN ) group and postoperative gastroparesis syndrome ( PGS) group ( ALB<35 g/L) .Methods Totally 187 patients with NS, 70 patients with CGN and 64 patients with PGS ( ALB <35 g/L ) were recruited before ALB, urinary protein ( UPR ) , urinary microalbuminuria/creatinine(Umalb/cr) and total bilirubin(TBIL) were detected.SPSS 17.0 Software was used to analyze the difference between the three groups and to reveal the correlations between TBIL and UPR, ALB.Results TBIL, ALB, UPR and Umalb/Cr levels were significantly different between NS, CGN and PGS groups ( one-way ANOVA test, P <0.05), and TBIL was positively correlated with ALB but negatively correlated UPR and Umalb/Cr in both NS and CGN groups (Spearman′s rho test,P<0.05);but no correlation was found between these items in PGS group (Spearman′s rho test,P>0.05) .Conclusion Serum bilirubin of patients with NS is at a low level and shows significant correlations with serum albumin and urinary protein levels.No similar association is found with the other two groups.The results in this study show that the causes of low serum bilirubin in patients with NS may related to the large amount of protein lost in urine.