Quest Diagnostics Urine Markers

Copper, 24 Hour Urine

Optimal Result: 15 - 60 mcg/24h.

Copper is an essential element that is a cofactor of many enzymes. Copper metabolism is disturbed in Wilson's disease, Menkes disease, primary biliary cirrhosis, and Indian childhood cirrhosis. Urinary copper concentrations are also useful to monitor patients on chealation therapy.

The biliary system is the major pathway of copper excretion. Biliary excretion of copper requires an adenosine triphosphate (ATP)-dependent transporter protein.

Variants in the gene for the transporter protein cause hepatolenticular degeneration (Wilson disease). Ceruloplasmin, the primary copper-carrying protein in the blood, is also reduced in Wilson disease.

What does it mean if your Copper, 24 Hour Urine result is too low?

Low urine copper levels are seen in malnutrition, hypoproteinemias, malabsorption, and nephrotic syndrome. Increased zinc consumption interferes with normal copper absorption from the gastrointestinal tract causing hypocupremia.

What does it mean if your Copper, 24 Hour Urine result is too high?

Humans normally excrete less than 60 mcg/day of copper in the urine.

Urinary copper excretion greater than 60 mcg/day may be seen in:

- Wilson disease (Urine copper excretion is increased in Wilson disease due to a decreased serum binding of copper to ceruloplasmin or due to allelic variances in cellular metal ion transporters.)

- Obstructive biliary disease (eg, primary biliary cirrhosis, primary sclerosing cholangitis)

- Nephrotic syndrome (due to leakage through the kidney)

- Chelation therapy

- Estrogen therapy

- Mega dosing of zinc-containing vitamins

Hypercupricuria (increased urinary copper) is also found in hemochromatosis, thyrotoxicosis, various infections, and a variety of other acute, chronic, and malignant diseases (including leukemia). Urine copper concentrations are also elevated in patients taking contraceptives or estrogens and during pregnancy.

Because ceruloplasmin is an acute phase reactant, urine copper is elevated during acute inflammation. During the recovery phase, urine copper is usually below normal, reflecting the expected physiologic response to replace the copper that was depleted during inflammation.

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