Remote digital urinalysis with smartphone technology as part of remote management of glomerular disease during the SARS-CoV-2 virus pandemic: single-centre experience in 25 patients

Abstract

Background The COVID-19 pandemic has necessitated the provision of healthcare through remote and increasingly digitalised means. The management of glomerular pathology, for which urinalysis is crucial, has been notably affected. Here, we describe our single-centre experience of using remote digital urinalysis in the management of patients with glomerular disease during the COVID-19 pandemic. Method All patients with native kidney glomerular disease who consented to participate in digital smartphone urinalysis monitoring between March, 2020 and July, 2021 were included. Electronic health records were contemporaneously reviewed for outcome data. Patient feedback was obtained through the testing portal. Results Twenty-five patient utilised the digital urinalysis application. A total of 105 digital urinalysis tests were performed for a wide variety of indications. Four patients experienced a relapse (detected remotely), and two patients underwent three successful pregnancies. The majority of patients were managed virtually (60%) or virtually and face to face (F2F) combined (32%). The average number of clinic reviews and urine tests performed during the pandemic either virtually and/or F2F was comparable to levels pre-pandemic and the ratio of reviews to urinalysis (R:U) was stable (pre-pandemic 1:0.9 vs during pandemic 1:0.8). Patients seen exclusively F2F with supplementary home monitoring had the highest R:U ratio at 1:2.1. 95% of users provided feedback, all positive. Conclusion Remote urinalysis proved a safe and convenient tool to facilitate decision making where traditional urinalysis was difficult, impractical, or impossible. Our approach allowed us to continue care in this vulnerable group of patients despite lack of access to traditional urinalysis.

Wearables in Nephrology: Fanciful Gadgetry or Prêt-à-Porter?

“…These issues will become more relevant when clinicians use multiple devices and platforms concurrently, and an industry standard for telemedicine and wearable devices would help mitigate against such an uncoordinated growth of portals. Cost implications also exist, and purpose-built interfaces to link a telemedicine application into an existing EHR typically cost four-figure to low five-figure sums [ 3 ]. Finally, the “Internet of Things” opens the doors for new vectors of attack, including malware and denial of service [ 92 ], together with unprecedented access to a patient’s lifestyle, location and habits with security implications.…”

“…Within nephrology, point-of-care testing (POCT) at home has recently received significant interest for a variety of applications [ 3 , 4 , 5 , 6 ]. However, none of these approaches currently exist in wearable form.…”

Point-of-Care Testing: Home Is Where the Lab Is

“…Nephrology relies heavily on urinalysis and it is therefore not surprising that digital urinalysis via smartphone technology is already widely used in a variety of clinical scenarios such as detection of urinary tract infection in renal transplant recipients 2 , screening for albuminuria in pregnant, hypertensive and diabetic patients, and for the monitoring of glomerular disease 3 . Measurement of both proteinuria and albumin to creatinine ratio is available, with validation studies demonstrating excellent correlation to traditional methods 3 . The frequency of home testing can be decided on an individual basis depending on clinical need, as recently illustrated 3 .…”

“…Measurement of both proteinuria- and albumin-creatinine ratios is available, with validation studies demonstrating excellent correlation to traditional methods (3). The frequency of home testing can be decided on an individual basis, depending on clinical need, as recently illustrated (3). It is legitimate to ask why one could not simply provide patients with traditional urine dipsticks for this purpose.…”

“…However, the traditional approach has pitfalls such as intra- or interuser variability, uncertainty interpreting results, or technical difficulties such as color blindness. The technology is easy to use, and the majority of patients preferred the smartphone-enabled approach (3).…”