The Importance of Manual Urine Microscopy

Research presented today at the National Kidney Foundation spring clinical meeting indicates that manual microscopy surpasses automated analyzers when assessing kidney injury. The abstract is titled “Manual Microscopy: Not a Lost Art” and says, in part: “In this study, we examined if a significant difference exists between the reported ranges of granular and muddy brown casts using manual microscopy as compared to an automated urine analyzer in an acute kidney injury cohort.”

According to one of the abstract’s authors, Dr. Sharda, “What our research has been able to show so far is that the automated system under reported the value of granular casts in our patient cohort of acute kidney injury. The automated system still has utility as a screening test, but manual microscopy should be done in all cases of abnormal kidney function, as accurate quantification of casts could have some prognostic benefit to patients.”

The poster is available online. The authors are currently writing a paper on their research; their contact information is here.

Mobile Technology and Health Care

I just stumbled upon this BBC article about a TED talk from about a year ago that discusses an app called Ucheck that can be used to test urine samples for a variety of elements, including glucose, proteins and nitrites.  Instead of having to go to a lab to get these urine tests, an individual can use this app—the purchase of which includes the dipsticks and supplies needed to utilize the app—to run initial urinalysis screening tests.

I imagine the Ucheck folks have thought about and researched the pros and cons and possible issues with a system like this.  Process issues, user error, contamination (although supposedly one of the elements in the test helps to gauge contamination), among others come to my mind immediately. My biggest question, however, is what does the Ucheck app-user do next after they receive their results? How does the patient proceed if they do need additional medical attention?

The internet can make mini doctors of all of us—there is enough information to make many self-diagnoses, but not necessarily accurate ones.  My doctor recently told me they have stopped giving patients full reports from various tests because they found the patients would go home and Google everything on the report and come back to them scared and with inaccurate information.  She said this Google-ing gives everyone access to enough information to be dangerous.  Would this app give people just enough information to be dangerous?

The TED talk mentions that the app is being put to the test in a laboratory in India—if effective that certainly could be very useful in terms of providing mobile health care, particularly in remote regions of the world.  Use of the app in a controlled medical setting where there are trained laboratory and medical personnel available to interpret results is a different story than an individual using it at home.

The TED talk and related articles I found were from 2013 so I did some sleuthing to see if I could find more recent information.  I found an article noting that the FDA sent the Ucheck developers a note that the app needs to meet FDA guidelines in order to be in use.  I didn’t find follow-up information on what happened after the FDA note, but I haven’t been able to find the app through my iPhone’s app store. Perhaps it’s been put on hold?

Regardless of whether this particular app moves forward, however, medical advances using mobile technology such as these are certainly on the horizon.  Which makes for an interesting conversation.  Mobile technology could be revolutionary in some parts of the developing world where access to medical resources is scarce.  But do they provide what is needed?  Are they being used in a setting where if a diagnosis is made there are resources to treat that diagnosis?

What do you think?  Are these positive developments?  Could they be helpful and harmful?  How will regulation work?

Levy

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.