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Test ID: CUU Copper, 24 Hour, Urine

Reporting Name

Copper, 24 Hr, U

Useful For

Investigation of Wilson disease and obstructive liver disease using a 24-hour urine specimen

Specimen Type

Urine


Necessary Information


24-Hour volume is required.



Specimen Required


Patient Preparation: High concentrations of barium are known to interfere with this test. If barium-containing contrast media has been administered, a specimen should not be collected for at least 96 hours.

Supplies: Urine Tubes, 10 mL (T068)

Collection Container/Tube: Clean, plastic urine collection container with no metal cap or glued insert

Submission Container/Tube: Plastic urine tube or clean, plastic aliquot container with no metal cap or glued insert

Specimen Volume: 10 mL

Collection Instructions:

1. Collect urine for 24 hours.

2. Refrigerate specimen within 4 hours of completion of 24-hour collection.

3. See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.

Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens in Special Instructions for multiple collections.


Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Reference Values

0-17 years: not established

≥18 years: 9-71 mcg/24 hours

Day(s) and Time(s) Performed

Monday; Continuously

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

82525

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CUU Copper, 24 Hr, U 5633-3

 

Result ID Test Result Name Result LOINC Value
8590 Copper, 24 Hr, U 5633-3
TM7 Collection Duration 13362-9
VL4 Urine Volume 3167-4

Clinical Information

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. 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.

 

Hypercupricuria (increased urinary copper) is also found in hemochromatosis, biliary cirrhosis, 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.

 

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.

Interpretation

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

-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

 

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.

Clinical Reference

1. Zorbas YG, Kakuris KK, Deogenov VA, et al: Copper homeostasis during hypokinesia in healthy subjects with higher and lower copper consumption. Tr Elem Electro. 2008;25:169-178

2. Lech T, Sadlik JK: Contribution to the data on copper concentration in blood and urine in patients with Wilson's disease and in normal subjects. Biol Trace Elem Res. 2007 July;118(1):16-20

3. Rifai N, Horwath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018

Analytic Time

1 day

Method Name

Inductively Coupled Plasma-Mass Spectrometry

Urine Preservative Collection Options

Note: The addition of preservative or application of temperature controls must occur within 4 hours of completion of the collection.

Ambient

OK

Refrigerate

Preferred

Frozen

OK

50% Acetic Acid

OK

Boric Acid

No

Diazolidinyl Urea

No

6M Hydrochloric Acid

OK

6M Nitric Acid

OK

Sodium Carbonate

No

Thymol

No

Toluene

No

Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Gastroenterology and Hepatology Client Test Request (T728)

-Inborn Errors of Metabolism Test Request (T798)

Mayo Clinic Laboratories | Gastroenterology Catalog Additional Information:

mml-gi-liver-genetic