Abstract
BackgroundHome monitoring of urine protein is a critical component of disease management in childhood nephrotic syndrome. We describe the development of a novel mobile application, UrApp – Nephrotic Syndrome Manager, to aid disease monitoring.MethodsUrApp was iteratively developed by a panel of two pediatric nephrologists and three research engineers from May 2017 to October 2018 for Apple iPhones. App features were devised by this expert panel to support urine monitoring and other home care tasks. Each feature and user-app interface element was systematically reviewed by the panel and iteratively redesigned to remove anticipated use issues. The app prototype was then refined based on two rounds of usability testing and semi-structured user interviews with a total of 20 caregivers and adolescent patients. The analytic function of UrApp in providing a camera read of the urine test strip was compared to a standard urinalysis machine using 88 patient urine samples and three iPhones, model versions 6S and 7. Exact agreement and weighted kappa were calculated between the UrApp and urinalysis machine reads.ResultsThe final UrApp features include: camera read of a urine test strip; analysis of urine protein trends and alerts for new disease relapse/remission; transmission of urine protein results to providers; education materials; and medication reminders. During the second round of UrApp usability testing, all users were able to perform each of the functions without error and all perceived UrApp to be helpful and indicated that they would use UrApp. UrApp camera results had 97% exact agreement and an overall weighted kappa value of 0.91 (95% CI, 0.85–0.97) compared with standard urinalysis machine interpretation.ConclusionsUrApp was specifically designed to support patients and families living with nephrotic syndrome by supporting disease monitoring and home management tasks. The technically innovative feature that makes this possible is the use of a smartphone camera to read the urine test strip. This novel tool has the potential to improve disease monitoring and reduce management burden.
Highlights
Home monitoring of urine protein is a critical component of disease management in childhood nephrotic syndrome
Overview of UrApp development In this prototype development research, UrApp was developed from concept to prototype through: 1. theoryinformed conceptual design of app features by content experts, 2. technical development including the innovative feature of camera read of a urine test strip, 3. analytic validation of the UrApp camera read compared to a standard urinalysis machine, and 4. iterative refinement of UrApp features based on usability testing and user feedback (Fig. 1)
The raw data of all 88 sample protein results by Urisys 1100 and UrApp are presented in Additional file 1: Table S1
Summary
Home monitoring of urine protein is a critical component of disease management in childhood nephrotic syndrome. We describe the development of a novel mobile application, UrApp – Nephrotic Syndrome Manager, to aid disease monitoring. Home urine testing for protein is recommended to detect disease relapse and remission in a timely manner. Cargivers are instructed to use urine reagent test strips - thin plastic strips with small blocks of paper impregnated with various regeants that produce visible colorimetric reactions once in contact with urine. One reagent block produces a semiquantitative result for urine protein that can be read by eye [3]. Caregivers are to alert their providers to the occurrence of proteinuria in a timely manner so that treatment can be initiated or adjusted to treat each relapse and prevent disease complications. Disease relapse is defined as urine protein ≥2+ (100 mg/dL) for 3 consecutive days and remission is defined as negative/trace urine protein for 3 consecutive days [2]
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