Urinary Copper 24 hours

Hormone/ Element

Report in 12Hrs

At Home

No Fasting Required

Details

Helps assess copper metabolism and is especially useful in diagnosing Wilson’s disease

₹949₹1,650

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Urinary Copper 24 Hours - Comprehensive Medical Test Guide

Why is it done?
- Measures the amount of copper excreted in urine over a 24-hour period to assess copper metabolism and homeostasis
- Diagnose Wilson's disease, a genetic disorder affecting copper accumulation in organs such as the liver, brain, and cornea
- Evaluate suspected copper toxicity or chronic copper exposure in occupational or environmental settings
- Monitor patients receiving chelation therapy or copper-binding medications
- Investigate cases of unexplained hepatic dysfunction, neuropsychiatric symptoms, or movement disorders
- Screen family members of patients diagnosed with Wilson's disease
- Assess copper nutritional status in patients on total parenteral nutrition or with malabsorption syndromes
Normal Range
- Reference Range: 15-60 μg/24 hours (0.24-0.95 μmol/24 hours), though this may vary by laboratory
- Units of Measurement: Micrograms per 24 hours (μg/24h) or micromoles per 24 hours (μmol/24h)
- Normal Result: Indicates adequate copper excretion and normal copper metabolism; absence of significant copper accumulation
- Elevated Result: Values exceeding 60 μg/24 hours suggest excessive copper excretion; typically seen in Wilson's disease, copper toxicity, or cholestasis
- Low Result: Values below 15 μg/24 hours may indicate copper deficiency or impaired copper excretion; less commonly abnormal than elevated levels
- Critical Values: Values >200 μg/24 hours warrant immediate clinical attention and investigation for acute copper toxicity or advanced Wilson's disease
Interpretation
- Significantly Elevated (>100 μg/24 hours): Strongly suggestive of Wilson's disease, particularly when combined with low serum ceruloplasmin and elevated serum copper; also seen in primary biliary cirrhosis and other cholestatic liver diseases
- Mildly to Moderately Elevated (60-100 μg/24 hours): May indicate early Wilson's disease, chronic copper exposure, cirrhosis of various etiologies, or chronic cholestasis; requires correlation with clinical findings and other tests
- Within Normal Range (15-60 μg/24 hours): Typically reassuring for Wilson's disease, though does not completely exclude early or asymptomatic disease; helpful for monitoring effectiveness of copper-chelating therapy
- Persistently Low (<15 μg/24 hours): May suggest copper deficiency, impaired renal function, or excessive chelation therapy; may also indicate retained copper in tissues with reduced urinary excretion
- Response to Chelation Therapy: In treated Wilson's disease patients, urinary copper typically remains 75-150 μg/24 hours; marked increases may indicate inadequate therapy or non-compliance
- Factors Affecting Results: Dietary copper intake, medications (copper supplements, penicillamine, trientine), renal function, hydration status, time of day variation, contamination from copper-containing containers, and presence of concurrent liver or kidney disease
- Clinical Significance Patterns: Very high values combined with low ceruloplasmin and high serum copper are pathognomonic for Wilson's disease; in cirrhotic patients without Wilson's disease, modest elevations are common due to cholestasis; occupational exposure history correlates with degree of elevation
Associated Organs
- Primary Organ Systems: Liver (primary copper metabolism and storage), kidneys (copper filtration and excretion), and central nervous system (copper accumulation causes neurotoxicity)
- Wilson's Disease: Autosomal recessive disorder of copper metabolism; manifests with hepatic cirrhosis, Parkinson-like movement disorders, psychiatric symptoms, Kayser-Fleischer rings (corneal copper deposition), hemolytic anemia, and renal dysfunction
- Hepatic Diseases: Primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), alcoholic cirrhosis, and viral hepatitis-induced cirrhosis show elevated urinary copper due to impaired hepatic copper clearance
- Neurological Complications: Copper neurotoxicity causes basal ganglia damage, resulting in tremor, rigidity, dystonia, ataxia, cognitive decline, depression, and psychosis; frontal lobe involvement may cause personality changes
- Ocular Manifestations: Kayser-Fleischer rings representing Descemet's membrane copper deposition are pathognomonic for Wilson's disease; sunflower cataracts may develop
- Hematologic Effects: Hemolytic anemia with acute hemolysis, Coombs test-negative; thrombocytopenia and coagulopathy may occur in acute presentation
- Renal Involvement: Copper-induced nephrotic syndrome, aminoaciduria, and proximal tubular dysfunction; chronic kidney disease may reduce urinary copper excretion
- Occupational Copper Exposure: Workers in copper mining, smelting, and manufacturing industries; chronic inhalation may cause respiratory disease, gastrointestinal irritation, and metal fume fever
Follow-up Tests
- Serum Ceruloplasmin: Low levels (<20 mg/dL) combined with elevated urinary copper are diagnostic for Wilson's disease; should be ordered simultaneously with 24-hour urinary copper
- Serum Copper and Free (Non-Ceruloplasmin-Bound) Copper: Elevated free copper levels indicate tissue copper accumulation; calculated as total serum copper minus ceruloplasmin-bound copper
- Slit-Lamp Examination: Essential to detect Kayser-Fleischer rings; present in nearly all patients with neurologic Wilson's disease but absent in some with isolated hepatic disease
- Liver Function Tests (LFTs): Assess hepatic synthetic function (albumin, PT/INR) and cholestasis (alkaline phosphatase, GGT); help differentiate etiology of liver disease
- Complete Blood Count (CBC): Evaluate for Coombs test-negative hemolytic anemia, thrombocytopenia, and leukopenia; important for assessing disease severity
- Coagulation Studies (PT/INR, aPTT): Assess for hepatic synthetic dysfunction and risk of bleeding; particularly important in acute hemolytic presentations
- Renal Function Tests (BUN, Creatinine, eGFR): Evaluate renal involvement and adjust dosing of chelation therapy; urinary abnormalities (proteinuria, hematuria) may indicate copper nephropathy
- Brain MRI: Recommended for patients with neurologic symptoms; shows characteristic signal changes in basal ganglia (putamen, substantia nigra), midbrain, and pons
- Abdominal Imaging (Ultrasound or CT): Assess for cirrhosis, portal hypertension, hepatomegaly, and screen for hepatocellular carcinoma risk
- Genetic Testing (ATP7B): Confirms Wilson's disease diagnosis by identifying ATP7B gene mutations; enables screening of asymptomatic family members
- Monitoring During Treatment: Repeat 24-hour urinary copper every 6-12 months in treated patients; target is typically 75-150 μg/24 hours; monitor serum copper and ceruloplasmin quarterly initially, then annually when stable
- Occupational Health Screening: In workplace copper exposure cases, repeat testing at 6-12 month intervals; correlate with workplace exposure monitoring and respiratory function tests
Fasting Required?
- Fasting: No
- Patient Preparation: Fasting is not required for this 24-hour urine collection; patient should maintain normal eating and drinking patterns throughout collection
- Collection Instructions: Collect all urine over exactly 24 hours in a clean, copper-free plastic container; discard first morning void, then start collection; collect all subsequent voids including the first morning void the next day
- Container Specifications: Must use acid-washed or copper-free plastic containers provided by the laboratory; copper contamination from inappropriate containers invalidates results and causes false elevations
- Preservative: Most laboratories do not require preservative; some may request refrigeration or addition of 6M HCl; follow specific laboratory instructions
- Medications - Do Not Discontinue: Continue all regular medications including chelation therapy (penicillamine, trientine, tetrathiomolybdate) or zinc supplementation without interruption; inform laboratory of all current medications
- Medications - Avoid if Possible: Copper supplements, vitamin preparations containing copper, and iron supplements (may interfere); discuss with healthcare provider before discontinuing
- Dietary Considerations: No dietary restrictions necessary; however, document high-copper diet foods consumed (nuts, shellfish, chocolate, organ meats) as these may affect results; avoid copper-contaminated water from copper pipes; use filtered or bottled water if indicated
- Hydration: Maintain normal fluid intake; dehydration may result in artificially low urine copper levels due to concentrated urine; ensure adequate urine volume is collected
- Timing of Collection: Perform 24-hour collection when stable on current medications and therapy; avoid collection during acute illness or stress when possible; document exact collection start and end times
- Sample Storage and Transport: Keep specimen refrigerated if not processed immediately; deliver to laboratory on same day of collection when possible; maintain chain of custody documentation

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