KEY POINTS
- Copper storage liver disease in dogs occurs when copper accumulates in the liver, leading to cell damage and even liver failure if left untreated.
- Some dogs may show no symptoms of excessive liver copper. Others develop vomiting, diarrhea, weight loss and even yellowing skin due to liver cell toxicity.
- Treatment involves reducing the amount of copper in the liver with special diets and medication.
Copper storage disease in dogs is a once-rare condition that is becoming increasingly common, causing concern for pet owners worldwide.
Copper storage liver disease occurs when copper accumulates in the liver, leading to liver damage and even liver failure if left untreated. But what causes this disease, and what can you do to help your furry friend?
In this article, we’ll delve into the causes, symptoms, and treatment for copper storage liver disease in dogs. By the end, you’ll better understand this condition and how to manage it.
OVERVIEW
What is copper storage disease?
Copper is a naturally occurring chemical element and an essential mineral for dogs. Dogs get most of their dietary copper from food and a small amount from water. Copper plays an important role in many metabolic processes.
Copper in food is absorbed in the small intestine and transported via the blood to the liver. The liver stores copper until it’s needed in the body. Unneeded copper is released from the liver in the bile and exits the body in feces.
The body normally carefully controls the amount of copper in the liver, storing a bit and releasing the extras. Copper storage disease occurs when this system fails and too much copper builds up in the liver.
Excessive amounts of copper are toxic enough to kill liver cells. When enough cells die, liver function is compromised and the dog starts to show symptoms of liver failure.
What is the difference between hepatitis and copper storage disease?
Hepatitis is a general term for liver inflammation. Causes include infection, poisonous plant ingestion, cancer and excessive copper stored in the liver cells.
Dietary excess and genetic copper storage disease can cause hepatitis. Some forms of hepatitis can also cause excessive copper storage due to decreased excretion of copper.
Which dogs does copper storage disease affect?
Copper storage disease can affect any breed, age or sex of dog. A few breeds have a known genetic predisposition
- Bedlington Terrier
- Corgi
- Dalmatian
- Doberman Pinscher
- Labrador Retriever
- Skye Terrier
- West Highland White Terrier
Females and middle-aged to older adult dogs are more likely to get the disease.
Dogs with other liver diseases such as chronic hepatitis or portosystemic shunts are more likely to develop copper storage problems in their liver.
How common is copper storage disease?
Copper storage disease is becoming more common in dogs. (4) Some experts speculate that modern vitamin/mineral premixes used in dog food play a role in the increased incidence of the disease.
How does copper storage disease affect my dog’s body?
Copper storage disease affects your dog’s liver. Some dogs may show no symptoms of excessive liver copper. Others develop vomiting, diarrhea, weight loss and even yellowing skin as a result of liver cell toxicity. Copper storage disease is not associated with liver cancer.
CAUSES & SYMPTOMS
Why do dogs get copper storage liver disease?
Copper storage problems are often multifactorial, but one or more of the following factors is responsible. Three ways dogs collect excessive amounts of copper in their liver
- Excessive copper in the diet
- Genetic errors that affect copper transport in the liver
- Liver disease that interferes with normal copper elimination
What are the symptoms of copper storage disease?
Not all dogs with excessive liver copper have symptoms even when very high levels of the mineral are present. Other dogs start to show signs of liver failure which can include
- Poor appetite and weight loss
- Vomiting and/or diarrhea
- Increased thirst and urination
- Abdominal discomfort, swelling, pain
- Fever, weakness, lethargy
- Pale gums, excessive bleeding
- Jaundice and yellowing of the eyes
- Seizures, disorientation, walking in circles
Is copper storage disease contagious?
Copper storage disease itself is not contagious to humans, dogs or other animals. Although less common, some causes of liver disease that lead to secondary copper storage disease are contagious. Consult your veterinarian about how to keep yourself and your other pets safe from contagious liver diseases.
Learn more about liver disease and failure in dogs…
DIAGNOSIS
How is copper storage liver disease diagnosed?
Canine copper storage disease diagnosis requires a liver biopsy sample. Evaluation is based on micrograms of copper per gram of dry weight of the liver.
- Normal: 400 micrograms or less of copper per gram of liver.
- Secondary copper storage disease: 400-1000 micrograms/gram.
- Primary/genetic copper storage disease: 1000 micrograms/gram or more.
What tests will be done to diagnose copper storage disease?
Your veterinarian will start by reviewing your dog’s health history and performing a physical exam. Diagnostic testing needed to find the cause of liver-related symptoms include
- Basic lab tests (CBC, blood chemistry, electrolytes, urinalysis) can show low red blood cell count, elevated liver enzymes (ALT, AST, ALP) and build-up of bilirubin waste.
- Liver function tests require testing blood samples before and after a meal to see if the bile acid level becomes abnormally elevated.
- Radiography and ultrasound imaging can evaluate the size, shape and internal architecture of the liver.
- Blood clotting tests to identify whether the liver disease has affected clotting proteins.
- Liver biopsy collects a small sample of liver tissue for a pathologist to examine microscopically for abnormal changes. Copper testing is also done on biopsy samples.
- Genetic testing can identify whether a dog has gene mutations responsible for abnormal copper transport.
TREATMENT
How is copper storage disease treated?
The main goal of treating copper storage disease in dogs is to reduce the amount of copper in the liver. This is done by decreasing copper consumption, decreasing copper absorption and helping the body get rid of excess copper stored in the liver.
Will a special diet help copper storage disease?
Since most of the copper a dog stores comes from their diet, feeding a low copper diet is helpful. Prescription diets with low copper levels include Hill’s Prescription Diet Liver Care l/d® and Royal Canin Veterinary Diets Hepatic®. You may also consider working with a veterinary nutritionist to create a low-copper homemade food recipe for your pup.
What medications can help lower copper levels in the liver?
Chelation therapy with a copper-binding medication called d-penicillamine (brand name Cupramine) can help decrease the copper stored in a dog’s liver. Penicillamine capsules or tablets are given orally twice a day. Some dogs need to take the drug for the rest of their life. Side effects of penicillamine include vomiting and decreased appetite.
Bile flow-promoting drugs (ursodiol) and liver supplements (vitamin E and silybin) may be used to protect the liver from the toxic effects of excess copper.
Finally, zinc can decrease the absorption of copper in a dog’s intestine. Zinc supplements may be recommended for maintenance after copper chelation therapy is finished.
How soon after treatment will my dog feel better?
With proper care, dogs with mild to moderate copper storage hepatopathy symptoms often start to feel better within one to two weeks. Dogs with severe forms of the disease need more aggressive treatment and may take longer to show signs of improvement.
PREVENTIVE CARE
Most dogs are not at risk for developing copper storage liver disease so no preventive measures are needed for them. Feeding high-quality dog food and keeping up their routine health care will support a healthy liver.
How can I reduce my dog’s risk?
If you have a dog breed that is at risk of copper storage disease, genetic testing, periodic blood testing and ultrasound imaging may help identify the problem early.
Avoid feeding at-risk breeds food containing a lot of dietary copper such as beef liver, oysters, potatoes, shiitake mushrooms, cashews, sunflower seeds and tofu. Check all vitamins and supplements for copper and consider using an alternative if it’s present.
Don’t breed a dog diagnosed with genetic copper storage disease. Their offspring will have a higher chance of getting the disease due to inherited genes.
PROGNOSIS
What can I expect if my dog has copper storage disease?
The prognosis is good for dogs with mild copper storage disease. Proper initial and ongoing treatment can keep them feeling well for years.
Bedlington Terriers tend to have more severe disease and often die between ages 2 and 6 years. (1) A 2009 study reported Labrador Retrievers had an estimated median survival time of 16.9 months. (3)
Dogs with liver scarring (cirrhosis) don’t fare as well. Depending on how severe the disease is at the time of presentation, they may die within a few days to a few months.
Can copper storage disease be cured?
Genetic forms of the disease cannot be cured. Secondary copper storage disease may be treated to the point that it is no longer a concern as long as the primary liver disease is controlled.
A lifelong copper-restricted diet is recommended for any dog diagnosed with copper storage liver disease.
Does my dog have liver failure?
Having high liver enzymes or high copper levels does not mean a dog has liver failure. Liver failure occurs when the liver can’t perform one or more of its primary functions. Dogs with liver failure typically have several of the symptoms listed above.
Your vet can perform liver function tests such as pre- and post-meal bile acids blood tests. If the results are abnormal, the dog’s liver function is impaired but may not be to the point of liver failure.
HOME CARE & MAINTENANCE
It’s important to follow your veterinarian’s instructions for medication, diet and follow-up visits. Keep these things in mind…
- Monitor your dog daily for changes in appetite, weight, and energy level and call your vet if you notice anything unusual.
- Follow the recommended diet and avoid foods high in copper.
- Stick to your recommended veterinary check-ups with blood and liver function tests.
When should my dog see their veterinarian?
See your vet if your dog shows any of the symptoms discussed earlier. Watch for changes in their appetite, thirst, urination or bowel habits. Also, consult your vet if you have trouble giving medication or getting your dog to eat the prescribed diet.
What questions should I ask the veterinarian?
- How can you tell if my dog has copper storage disease?
- If my dog doesn’t have copper storage disease, what other liver condition might they have?
- Is there a specific diet that you recommend?
- Should I see a specialist?
- What food, drugs and supplements should I avoid giving to my dog?
- What medications do you recommend?
- How will I know if my dog is getting better or worse?
- When should I bring my dog to you for a recheck?
- What at-home treatments do you recommend?
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References
- Brewer, G. J. (1998). Wilson disease and canine copper toxicosis. The American journal of clinical nutrition, 67(5), 1087S-1090S.
- National Institutes of Health Office of Dietary Supplements. (n.d.). Copper Fact Sheet for Health Professionals. Retrieved March 5, 2023, from https://ods.od.nih.gov/factsheets/Copper-HealthProfessional/
- Poldervaart, J. H., Favier, R. P., Penning, L. C., Van den Ingh, T. S. G. A. M., & Rothuizen, J. (2009). Primary hepatitis in dogs: a retrospective review (2002–2006). Journal of Veterinary Internal Medicine, 23(1), 72-80.
- Twedt, D., DVM, DACVIM. (n.d.). Copper-Associated Liver Disease: An Emerging Disease in Dogs. Western Veterinary Conference 2020, Fort Collins, Colorado, United States of America.
- Webster, C. R., Center, S. A., Cullen, J. M., Penninck, D. G., Richter, K. P., Twedt, D. C., & Watson, P. J. (2019). ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs. Journal of veterinary internal medicine, 33(3), 1173-1200.
