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 digitalized 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 patients utilized 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 versus during the pandemic 1:0.8). Patients seen exclusively F2F with supplementary home monitoring had the highest R:U ratio at 1:2.1. A total of 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 a lack of access to traditional urinalysis.

Keywords: glomerular disease; smartphone technology; telemedicine; urinalysis.

FIGURE 1:

Underlying kidney diseases in our cohort of patients (n = 25).

FIGURE 2:

Digital smartphone urinalysis testing kit comprising a collection beaker, single urine dipstick and colour chart. The Dip.io urinalysis dipstick measures 10 different parameters (range of values in brackets): leukocytes (negative or 15/70/125/500 leukocytes/µL), nitrates (negative or positive), glucose (negative or 100/250/500/1000 mg/dL), ketones (negative or 5/15/40/80 mg/dL), protein (negative or 15/30/100/300 mg/dL), blood (negative or 10/25/80/200 erythrocytes/µL), pH (5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5 or 9.0), urobilinogen (negative or 1/2/4/8 mg/dL), bilirubin (negative or 1/2/4 mg/dL) and specific gravity (1.000, 1.005, 1.010, 1.015, 1.020, 1.025 or 1.030). The dipstick result is analysed and processed via the smartphone camera using the company app (versions for Apple and Android are available). The results are then uploaded onto a secure portal and the overseeing clinician is notified of the new result. Currently one pack contains four tests, which can be reordered prior to the last test being used. Illustration courtesy of Health.io (Tel Aviv, Israel) reproduced with permission.

FIGURE 3:

Clinical pathway of digital urinalysis from test delivery to online result. Pictures courtesy of Health.io (Tel Aviv, Israel), reproduced with permission. SMS: short message service (text message).

FIGURE 4:

Timeline of a patient with relapsing MCD with proteinuria (as determined by smartphone technology and confirmed by formal uPCR), appointments and key interventions. Changes in the steroid dose are not shown. The patient experienced two relapses of MCD during the study period with increased proteinuria detected via digital smartphone urinalysis and subsequently confirmed by uPCR. During the first relapse, the immunosuppression was up-titrated before the onset of symptoms and the patient achieved clinical remission and normalization of proteinuria. This was followed by a second relapse with clinical symptoms confirmed on immediate testing via smartphone technology. Remission was eventually achieved following treatment with rituximab. Note that the patient was reviewed almost exclusively virtually (16 reviews) during the pandemic.