Sterile Urine Collection Mechanism for Medical Diagnostic Systems
20230329642 · 2023-10-19
Inventors
- Michael Tu (Skokie, IL, US)
- Claire Zhou (Chicago, IL, US)
- Peter Nebres (Chicago, IL, US)
- Prasanth Bijjam (Schaumburg, IL, US)
- Eric Shain (Glencoe, IL, US)
- Craig Sampson (Lake Bluff, IL, US)
Cpc classification
E03D11/13
FIXED CONSTRUCTIONS
A61B2562/0295
HUMAN NECESSITIES
A61B5/14546
HUMAN NECESSITIES
International classification
A61B5/00
HUMAN NECESSITIES
A61B10/00
HUMAN NECESSITIES
A61B5/20
HUMAN NECESSITIES
E03D11/13
FIXED CONSTRUCTIONS
Abstract
Example embodiments relate to a sterile urine collection mechanism for medical diagnostic systems. An example device includes an initial collection component configured to collect a midstream urine sample from a patient. The device also includes a plurality of test strips configured to indicate a condition of the patient at a point of care. In addition, the device includes a sensor configured to capture an image of at least one test strip exposed to a portion of the midstream urine sample. Further, the device includes a computing device configured to analyze the image of the test strip captured by the sensor in order to determine the condition of the patient. Even further, the device includes a motor configured to position the test strip near the sensor. Yet further, the device includes an additional collection component configured to collect an additional portion of the midstream urine sample for central laboratory testing.
Claims
1. A device comprising: an initial collection component configured to collect a midstream urine sample from a patient; a plurality of test strips configured to indicate a condition of the patient when exposed to the midstream urine sample; a fluid transportation system configured to: transport a portion of the midstream urine sample from the initial collection component to at least one test strip of the plurality of test strips; and expose the at least one test strip to the portion of the midstream urine sample; a sensor configured to capture an image of the at least one test strip exposed to the portion of the midstream urine sample, wherein the image of the at least one test strip indicates the condition of the patient at a point of care; a computing device configured to analyze the image of the at least one test strip captured by the sensor in order to determine the condition of the patient at the point of care; a motor configured to position the at least one test strip near the sensor after the at least one test strip is exposed to the portion of the midstream urine sample; and an additional collection component configured to collect an additional portion of the midstream urine sample from the initial collection component for central laboratory testing.
2. The device of claim 1, further comprising a midstream urine collection seat, wherein the midstream urine collection seat comprises the initial collection component, wherein the seat is raised or lowered mechanically using an electric motor, wherein the seat is mechanically lowered into a lowered position to collect urine from the patient for testing, and wherein the seat is mechanically raised into a raised position after urine has been collected from the patient.
3. The device of claim 1, wherein the additional collection component comprises a sterile collection cup, wherein the sterile collection cup has one or more barcode stickers disposed thereon, and wherein a barcode on the one or more barcode stickers matches a barcode on a bracelet worn by the patient.
4. The device of claim 1, wherein the initial collection component comprises a rigid central platform with a film overlaid over the platform to absorb an initial urine stream and collect the midstream urine sample, wherein: the rigid central platform comprises an anti-microbial coating and a hydrophobic coating; the film comprises a trough in a center of the film; the film comprises absorbent strips spaced at discrete intervals on the film to absorb the initial urine stream and collect the midstream urine sample, wherein the absorbent strips comprise sodium polyacrylate; the film comprises holes; or the film comprises shapes made of water-soluble plastic, wherein the film is stabilized using a guide wire, wherein the film comprises two circular layers of water-soluble, polyvinyl alcohol (PVA) over which the midstream urine sample collects, and wherein the midstream urine sample dissolves the two circular layers within a few seconds of collecting over the two circular layers.
5. The device of claim 1, wherein the initial collection component comprises a rigid central platform made of polyoxymethylene plastic that is coated with an anti-microbial coating and a hydrophobic coating, wherein the initial collection component comprises a rigid central platform comprising an array of holes connected to a membrane and a vacuum pump located inside the rigid central platform, and wherein the initial collection component comprises a film and a rigid contoured base.
6. The device of claim 1, wherein the initial collection component comprises a backside curvature configured to hold the midstream urine sample when the initial collection component is raised.
7. The device of claim 1, wherein the initial collection component comprises a film, and wherein, after use, the film is unrolled from over the initial collection component and a replacement film is rolled over the initial collection component.
8. The device of claim 1, further comprising an instruction screen configured to provide a demonstration on how to use the device, wherein the demonstration comprises static drawings, videos, or audio.
9. The device of claim 1, wherein the initial collection component comprises a platform having an open space defined therein for disposal of toilet paper into a toilet bowl below the platform.
10. The device of claim 1, wherein the additional collection component comprises a sterile collection cup, wherein the device further comprises a predefined location for the additional collection component, and wherein the predefined location is revealed using an electronic signal or mechanical method.
11. The device of claim 1, wherein the initial collection component comprises a rigid platform overlaid with film, wherein the platform is positioned over a toilet bowl, wherein the additional collection component comprises a sterile collection cup, wherein the platform is raised in response to a flush lever of the toilet being pushed, and wherein the midstream urine sample is at least partially transferred from the collection component to the additional collection component upon the platform being raised.
12. The device of claim 1, further comprising a refillable reservoir configured to provide clean water for flushing and device sterilization functions.
13. The device of claim 1, further comprising a battery backup, wherein the device is mobile and portable.
14. The device of claim 1, wherein transporting the portion of the midstream urine sample from the initial collection component to the at least one test strip of the plurality of test strips is performed using a y-shaped tubing apparatus controlled by a three-way solenoid valve and a tubing pathway, wherein the tubing pathway bifurcates into a first tubing pathway and a second tubing pathway, wherein the first tubing pathway is directed to the at least one test strip, and wherein the second tubing pathway is directed to a waste basin in the device and then to a toilet bowl.
15. The device of claim 1, wherein the at least one test strip is configured to indicate the presence of a uremic toxin, a biomarker associated with cardiovascular disease, or a biomarker associated with chronic kidney disease, and wherein the uremic toxin, the biomarker associated with cardiovascular disease, or the biomarker associated with chronic kidney disease comprise urea, phosphate, creatinine, parathyroid hormone (PTH), beta 2 microglobulin, cystatin C, myoglobin, kappa free light chains, complement factor D, interleukin-6, alpha 1 microglobulin, YKL-40, lambda free light chains, albumin, indoxyl sulfate, indoxyl glucuronide, indoleacetic acid, P-Cresyl sulfate, P-Cresyl glucuronide, phenyl sulfate, phenyl glucuronide, phenylacetic acid, phenylacethyl glutamine, hippuric acid, 4-Ethylphenyl sulfate, or 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid.
16. The device of claim 1, further comprising: an additional sensor configured to capture an image of the midstream urine sample, wherein the image of the midstream urine sample indicates an extent of dehydration of the patient, and wherein the computing device is configured to analyze the image of the midstream urine sample in order to determine the extent of dehydration of the patient by determining a color and darkness of the midstream urine sample; and a refractometer, wherein the at least one test strip indicates the extent of dehydration of the patient, and wherein the computing device is configured to analyze the image of the at least one test strip or data from the refractometer in order to determine the extent of dehydration of the patient by determining a concentration of the midstream urine sample or a specific gravity of the midstream urine sample.
17. The device of claim 1, wherein the condition of the patient comprises ovulation, and wherein the plurality of test strips are configured to indicate the presence of luteinizing hormone.
18. The device of claim 1, wherein the device is configured to fit around or over consumer toilets in an at-home setting or a senior care setting.
19. A system comprising: a device comprising: an initial collection component configured to collect a midstream urine sample from a patient; a plurality of test strips configured to indicate a condition of the patient when exposed to the midstream urine sample; a fluid transportation system configured to: transport a portion of the midstream urine sample from the initial collection component to at least one test strip of the plurality of test strips; and expose the at least one test strip to the portion of the midstream urine sample; a sensor configured to capture an image of the at least one test strip exposed to the portion of the midstream urine sample, wherein the image of the at least one test strip indicates the condition of the patient at a point of care; a computing device configured to analyze the image of the at least one test strip captured by the sensor in order to determine the condition of the patient at the point of care; a motor configured to position the at least one test strip near the sensor after the at least one test strip is exposed to the portion of the midstream urine sample; and an additional collection component configured to collect an additional portion of the midstream urine sample from the initial collection component for central laboratory testing; and a toilet bowl onto which the device is attached.
20. A method comprising: collecting a midstream urine sample from a patient in an initial collection component; transporting a portion of the midstream urine sample from the initial collection component to at least one test strip using a fluid transportation system; exposing, by the fluid transportation system, the at least one test strip to the portion of the midstream urine sample, wherein the at least one test strip is one of a plurality of test strips configured to indicate a condition of the patient when exposed to the midstream urine sample; positioning, by a motor, the at least one test strip near a sensor; capturing an image of the at least one test strip using the sensor, wherein the image indicates the condition of the patient at a point of care; analyzing, by a computing device, the image of the at least one test strip in order to determine the condition of the patient at the point of care; and collecting, from the initial collection component, an additional portion of the midstream urine sample in an additional collection component for central laboratory testing.
Description
BRIEF DESCRIPTION OF THE FIGURES
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DETAILED DESCRIPTION
[0100] Example methods and systems are described herein. Any example embodiment or feature described herein is not necessarily to be construed as preferred or advantageous over other embodiments or features. The example embodiments described herein are not meant to be limiting. It will be readily understood that certain aspects of the disclosed systems and methods may be arranged and combined in a wide variety of different configurations, all of which are contemplated herein.
[0101] Furthermore, the particular arrangements shown in the figures should not be viewed as limiting. It should be understood that other embodiments might include more or less of each element shown in a given figure. In addition, some of the illustrated elements may be combined or omitted. Similarly, an example embodiment may include elements that are not illustrated in the figures.
[0102] The following disclosure is provided to describe various embodiments of a medical diagnostic system. Skilled artisans will appreciate additional embodiments and uses of the present invention that extend beyond the examples of this disclosure. Terms included by any claim are to be interpreted as defined within this disclosure. Singular forms should be read to contemplate and disclose plural alternatives. Similarly, plural forms should be read to contemplate and disclose singular alternatives. Conjunctions should be read as inclusive except where stated otherwise.
[0103] Expressions such as “at least one of A, B, and C” should be read to permit any of A, B, or C singularly or in combination with the remaining elements. Additionally, such groups may include multiple instances of one or more element in that group, which may be included with other elements of the group. All numbers, measurements, and values are given as approximations unless expressly stated otherwise.
[0104] Various aspects of the present disclosure will now be described in detail, without limitation. In the following disclosure, a platform for a sample collection mechanism that may be used as part of a medical diagnostic system will be discussed. Those of skill in the art will appreciate alternative labeling of the sample collection mechanism as a collection platform, a urine collection platform, a sample collection platform, or other similar names. Skilled readers should not view the inclusion of any alternative labels as limiting in any way.
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[0112] The process starts when the patient urinates into the collector 7. As the patient urinates into the collector 7, any urine that exceeds the volume of the collector 7 may overflow into the toilet bowl. The absorbent strips 13 capture the initial stream and become saturated. This enables a clean catch to be performed as the initial urine is in at least one of the absorbent strips 13. The film 15 rolls over the rigid contoured base 14 to maintain a smooth curved shape in the middle of the toilet. When the platform 2 raises, the urine collects via gravity above the two dissolvable stoppers 12 or ramps 20 in the back side of the collector 7. After some time such as 10 seconds, the urine dissolves the dissolvable stoppers 12 and drops via gravity into the sterile collection cup 8 for downstream lab tests and a fixed collection reservoir 18 connected to the diagnostic device 6. Patient pushes the flush handle on the toilet or activates the flush mechanism on the toilet. Delayed flush that is controlled by the device 6 occurs after the testing is complete.
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[0118] The analysis of the urine sample will now be discussed in more detail. The urine sample may be analyzed using hyperspectral imaging, multispectral imaging, or a spectrophotometer implementation in disclosures with or without the urine collection mechanism.
[0119] The analysis of the urine sample using a diagnostic device with a cassette will now be discussed in more detail. The cassette may hold a plurality of test strips. The cassette may have bleach powder to sterilize the entire diagnostic system, plus urine collection mechanism.
[0120] An alternative method of sterilizing the urine collector 7 will now be discussed in more detail. Another method to sterilize the urine collector 7 would be to use a light source like an ultra-violet light source.
[0121] A method of collecting the urine will now be discussed in more detail. A sponge or sponge-like material could be used to collect the urine. The sponge could absorb the urine and then release the urine by self-squeezing the sponge or by squeezing the sponge using a set of rollers that are covered with film.
[0122] Another method of collecting the urine will now be discussed in more detail. A non-contaminative material may be used to collect the urine such as water or a powder. The powder may melt as the urine hits the material.
[0123] Another method of collecting the urine will now be discussed in more detail. An inclined urine collector may be used. The urine may hit the inclined collector. Water may be flowing down the collector during urination. The urine may then be collected in a container. The container may be at the bottom of the incline or in the middle of the incline.
[0124] Another method of analyzing and collecting the urine will now be discussed in more detail. A sensor may be placed on the inside of the bowl of the toilet. The sensor may be installed inside the bowl of the toilet or the sensor may be attached to an arm on the side of the bowl. The urine may flow through the sensor and a result may be determined using a method, such as spectrophotometry. The sensor may have anti-microbial coating on the inside of the sensor and the outside of the sensor.
[0125] Another method of analyzing and collecting the urine will now be discussed in detail. Some embodiments may include a robotic arm with an open collection cup that uses visual sensors to find the stream of urine, capture the urine, and finally cap the collection cup.
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[0143] Another method for the installation of the urine collector will be discussed. The urine collector may be installed inside the bowl of the toilet and connect to the plumbing of the toilet.
[0144] Another set of tests that may be tested by the diagnostic device will be discussed. The diagnostic device could test for pH, chloride levels, glucose, lactate, sodium, potassium, and other metabolites, hormones, and proteins that could be in urine. The diagnostic device could use chemistry-based tests, antibody-based tests, or aptamer-based tests for diagnosis.
[0145] The device may have a custom flush valve that replaces the original flush valve of the toilet. The custom flush valve may route water to the toilet and to the device.
[0146] An add-on device to toilets as described herein may automate point-of-care pregnancy urine testing from specimen collection through testing to delivery of results, improving operational efficiencies in EDs. To satisfy complementary clinical and operational requirements, the device also collects and transfers sterile midstream urine to an external urine collection cup for additional point-of-care (POC) and centralized laboratory testing. Against available options in manual and semi-automated POC tests, the device described herein may provide better or comparable performance in terms of speed, cost, accuracy, and user experience. In the ED, the solution will decrease patient length of stay, reduce labor costs, reduce human errors, and improve the patient and clinical staff experience. The embodiments described herein will improve the quality, safety, and efficiency of ED care.
[0147] The existing manual and semi-automated POC pregnancy testing systems were analyzed and it was determined that the existing systems did not overcome and satisfy these 5 key technical challenges and requirements needed for a POC system to be considered a diagnostic system that fully automates POC urine pregnancy testing: 1) Full automation from urine collection through testing to delivery of results; 2) Sterile collection and transfer of midstream urine without dilution; 3) Control of sample volume; 4) Test strip automation; 5) Prevention of cross-contamination of pregnancy test results from different patients.
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[0154] The patient sits on or squats above the urine collector 7 as if it were a toilet seat, and urinates into the collector 7 as if it were the toilet bowl. The urine collector 7, made from polyoxymethylene plastic (DELRIN), has a central platform 2 above the toilet bowl that is rigid and curved. This platform 2 spans the toilet bowl, so the patient may urinate into the platform without aiming, and the platform's curved basin will collect the urine. It is understood that the central platform may be made from other plastics as well (e.g., polyvinyl chloride (PVC), polypropylene (PP), polyethylene (PE), polystyrene (PS), nylon, polyethylene terephthalate (PET), polyimide (PA), polycarbonate (PC), acrylonitrile butadiene (ABS), polyetheretherketone (PEEK), and/or polyurethane (PU)). In some embodiments, the central platform 2 may be made from metal (e.g., stainless steel and/or aluminum). The central platform 2 may be attached to the overall device or the diagnostic device 6. The diagnostic device 6 may be attached to the flushometer of the toilet. In some embodiments, the central platform 2 may be attached to the toilet seat hinge above the toilet bowl.
[0155] The central platform has an array of holes that are connected to a small, membrane, vacuum pump (e.g., a direct current (DC) diaphragm vacuum pump) situated inside of the platform. For each patient, the platform is covered by fresh unused, water-insoluble polyethylene terephthalate (PET) plastic film, which is rolled onto the platform by a reel-to-reel, stepper motor mechanism and a guide wire on the urine collection sub-system. The vacuum pump generates a vacuum that holds the fresh film down against the platform, causing the film to conform to the curved shape of the platform 2. When the patient urinates into the urine collector 7, the urine is collected by the fresh film over the platform, maintaining the sterility of the urine sample since urine from different patients never touch the same surface. Moreover, since the platform collects the urine without the urine reaching the toilet bowl where water is, the sample is not diluted. When the urine collector 7 pivots upward to transfer the urine into the pregnancy analyzer and external urine collection cup, sterility is also maintained because the film covers the rigid contoured base 14 and holes beneath the guide wire.
[0156] The film is coated with sodium polyacrylate, which swells upon contact with the initial urine and absorbs the initial urine, so that only the midstream urine and onward is collected and transferred by the urine collector 7.
[0157] The sample volume control and dispense mechanism will now be discussed. The sample volume control and dispense mechanism 22 collects a fixed volume of urine that is dispensed onto each test strip. This mechanism is a y-shaped tubing apparatus controlled by a three-way solenoid valve. The tubing pathway bifurcates into two tubing pathways. The first pathway collects a fixed volume of urine to be dropped onto each test strip. The second pathway allows excess urine not needed for the analysis to flow through into a waste basin, where the urine is routed into the toilet bowl to be flushed. The sample volume may be a fixed volume (e.g., 1 mL of urine), which would be the same amount for all patients. Alternatively, the sample volume may depend on the conditions being tested. In some embodiments, the 3-way solenoid may be controlled by an open/close valve that is electronically powered. The first pathway may be filled by closing the waste pathway with the valve to allow the first pathway to fill with the fixed volume (e.g., 1 mL), and then the waste (second) pathway may open for additional waste urine while closing the first pathway. After a set amount of time (e.g., 30 seconds), the first pathway may again be opened (and the second and waste pathway may again be closed by the valve) to drop the fixed volume (e.g., 1 mL) of urine onto the test strip. The waste basin may be shaped like a rectangular prism with an open ceiling and a hole for a pipe at the bottom. Alternatively, the waste basin may be circular or pyramidal. The excess urine goes first into the waste basin (e.g., because, in some cases, the urine analysis subsystem may be sufficiently separate from the toilet bowl to allow for the waste to go directly to the bowl).
[0158] The test strip automation will now be discussed. A disposable cassette holds a multitude of lateral flow immunochromatographic assay urine pregnancy test strips 24 on a film in a test strip automation mechanism 23 (e.g., in a reel-to-reel configuration). The clinical staff inserts the cassette into the pregnancy analyzer's reel-to-reel, stepper motor mechanism, which automates the usage of test strips for the next 100 patients. For each patient, the stepper motors spin to bring a new test strip under the sample volume control and dispense mechanism to receive the urine sample, and then under the optical imager for analysis. The dynamic positioning of the test strip is accurately controlled by opto-interrupter sensors.
[0159] Prevention of cross-contamination of pregnancy test results from different patients will now be discussed. During each analysis cycle, the pregnancy analyzer washes itself with a diluted sodium hypochlorite (bleach) solution, which denatures and removes any residual hCG that is on tubing walls or urine collection basins without damaging the tubing or basins. The diagnostic device 6 then washes away the sodium hypochlorite with water so that hCG results at sensitivity are not impacted by residual sodium hypochlorite.
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[0161] When the PVA layers dissolve, gravity will cause the urine to drain into both the pregnancy analyzer's urine collection basin and the external urine collection cup. The pregnancy analyzer analyzes the urine for the pregnancy status of the patient. Meanwhile, the patient removes the external urine collection cup and leaves it at a location designated by the clinical staff inside/outside of the restroom.
[0162] When all of the urine has drained from the urine collector, a solenoid valve releases the vacuum generated by the vacuum pump from the urine collector, releasing the PET film from the central platform 2. The reel-to-reel stepper motors roll away used film and bring unused film over the central platform. The vacuum reactivates to hold the fresh film down against the central platform, ready to collect the next patient's sterile midstream urine.
[0163] The PET film is on a roll within a disposable cassette that is discarded/replaced by clinical staff once per day. The PET film is coated with a layer of sodium polyacrylate (SPA). SPA swells upon contact with the initial urine stream and absorbs it. SPA saturates and does not absorb the sterile midstream urine. Hence, the urine collector's PET film only collects/transfers sterile midstream urine into the external urine collection cup and the pregnancy analyzer.
[0164] The materials and components will now be discussed. The materials and components described that comprise the urine collector are commonly used in prototyping due to their ease of prototyping, or easily sourced from off the shelf.
[0165] Conforming the film to the curved shape of the central platform 2 via the vacuum is a potential technical challenge. To mitigate this risk, the PET film will be looped around a guide wire at the top of the drainage basin to guide its positioning, and opto-interrupter sensors will be used to accurately position the PET film. If needed for optimization, alternative common film materials may be used such as polyethylene or polyvinylidene chloride.
[0166] A use case for the invention will now be discussed. A diagnostic smart toilet platform device according to example embodiments may be deployed on toilets in the home and in clinical settings, such as dialysis clinics, to improve chronic kidney disease management and prevent patients from “crashing” into dialysis. For Stage 1 to 3 chronic kidney disease patients (early to mid-stage patients) and Stage 4 to 5 chronic kidney disease patients (late stage patients), devices disclosed herein may monitor the concentration of urinary chronic kidney disease biomarkers, such as beta-trace protein, in the patients whenever the patients urinate into toilets.
[0167] This monitoring may take place at various frequencies, such as whenever the patients urinate into a toilet, multiple times per day, once per day, once per week, multiple times per week, once per month, multiple times per month, multiple times per year, once per year, etc.
[0168] By monitoring the urinary biomarker concentrations, clinicians, such as nephrologists, may remotely monitor the progression of the chronic kidney disease in patients over time, especially from the patient's home. By monitoring the progression of chronic kidney disease, the clinician may manage the chronic kidney disease, and plan with the patient in advance what the appropriate treatment options are, preventing the patient from “crashing” into dialysis when the patient needs emergency dialysis because the chronic kidney disease has not been monitored, managed, or planned for treatment in advance by the clinician with the patient. When the patient “crashes” into dialysis, clinical outcomes decrease, economic costs increases, and the patient's lifestyle, lifestyle flexibility, and patient experience are adversely impacted. The optimal dialysis treatment option is not able to be performed without the pre-planning.
[0169] As an example, when an example device is installed in the patient's home, the clinician may remotely monitor when a Stage 3 patient is approaching Stage 4 of chronic kidney disease, when patients typically need to begin dialysis. This provides the clinician and patient enough time to plan the appropriate treatment options for the late stage chronic kidney disease (Stage 4 or Stage 5), such as whether the patient should be prescribed peritoneal dialysis from the home or receive hemodialysis in a dialysis clinic. A similar application may be performed for Stage 4 patients approaching Stage 5.
[0170] To receive peritoneal dialysis from the home, the patients need to be trained and the clinicians require advance preparatory time, which can take at least 2 weeks. Currently, when a patient “crashes” into dialysis, pre-planning of the treatment has not occurred, so there is not enough advanced preparatory or training time to enable the patient to be put on peritoneal dialysis from the home, which can improve clinical outcomes, reduce economic costs, and improve the patient's lifestyle, lifestyle flexibility, and patient experience. As a result, the patient has to receive emergency hemodialysis from the hospital or a dialysis clinic.
[0171] Example devices disclosed herein may convert the urinary biomarker concentrations (such as beta-trace protein) into the glomerular filtration rate, which is used to determine the stage and progression of the chronic kidney disease.
[0172] A diagnostic smart toilet platform device according to example embodiments may test the urine of chronic kidney disease patients to diagnose and monitor them for early to late stages of chronic kidney disease (Stages 1 through 5), from the home or in clinical settings. To achieve this goal, the device may test the urine for multiple threshold, beneath-threshold, between-threshold, and above-threshold concentrations of urinary biomarkers of chronic kidney disease. Urinary biomarkers of chronic kidney disease may include: [0173] i. Albumin [0174] ii. Creatinine [0175] iii. Albumin to creatinine ratio [0176] iv. Cystatin C [0177] v. Cystatin C to creatine ratio [0178] vi. β2-microglobulin [0179] vii. β2-microglobulin to creatinine [0180] viii. Retinol-binding protein (RBP) [0181] ix. Retinol-binding protein (RBP) to creatinine ratio [0182] x. Beta-trace protein [0183] xi. Beta-trace protein to creatinine ratio.
[0184] Other urinary biomarkers of chronic kidney disease are also possible. Devices disclosed herein may test for one or more urinary biomarkers of chronic kidney disease using test strips packaged within one or more test cartridges. These test strips target the one or more urinary biomarkers of chronic kidney disease. The test strips may be lateral flow test strips that are antibody or aptamer based. The test strips may also be based on general chemistries.
[0185] A diagnostic smart toilet platform device according to example embodiments may test the urine of chronic kidney disease patients to diagnose and monitor them for uremic toxins (and/or biomarkers) associated with cardiovascular disease or chronic kidney disease, from the home or in clinical settings. To achieve this goal, the device may test the urine for multiple threshold, beneath-threshold, between-threshold, and above-threshold concentrations of the uremic toxins or biomarkers associated with cardiovascular disease or chronic kidney disease. In some embodiments, the device may test for the uremic toxins or biomarkers qualitatively or determine their concentrations semi-quantitatively or quantitatively. The concentrations of the uremic toxins or biomarkers may be determined by an onboard controller in the device. The thresholds may be predefined, in some embodiments. Further the device may be configured to determine a ratio of multiple biomarkers or uremic toxins by comparing their respective concentrations. For example, the device may be configured to determine a concentration of urea and a concentration of creatinine and then, based on the two concentrations, calculate a urea to creatinine ratio. This could similarly be done for other biomarkers and/or uremic toxins, as well. Uremic toxics or biomarkers associated with cardiovascular disease or chronic kidney disease may include: [0186] i. Urea [0187] ii. Urea to creatinine ratio [0188] iii. Phosphate [0189] iv. Phosphate to creatinine ratio [0190] v. Creatinine [0191] vi. Parathyroid hormone (PTH) [0192] vii. Parathyroid hormone to creatinine ratio [0193] viii. Beta 2 microglobulin [0194] ix. Beta 2 microglobulin to creatinine ratio [0195] x. Cystatin C [0196] xi. Cystatin C to creatinine ratio [0197] xii. Myoglobin [0198] xiii. Myoglobin to creatinine ratio [0199] xiv. Kappa free light chains [0200] xv. Kappa free light chains to creatinine ratio [0201] xvi. Complement factor D [0202] xvii. Complement factor D to creatinine ratio [0203] xviii. Interleukin-6 [0204] xix. Interleukin-6 to creatinine ratio [0205] xx. Alpha 1 microglobulin [0206] xxi. Alpha 1 microglobulin to creatinine ratio [0207] xxii. YKL-40 [0208] xxiii. YKL-40 to creatinine ratio [0209] xxiv. Lambda free light chains [0210] xxv. Lambda free light chains to creatinine ratio [0211] xxvi. Albumin [0212] xxvii. Albumin to creatinine ratio [0213] xxviii. Indoxyl sulfate [0214] xxix. Indoxyl sulfate to creatinine ratio [0215] xxx. Indoxyl glucuronide [0216] xxxi. Indoxyl glucuronide to creatinine ratio [0217] xxxii. Indoleacetic acid [0218] xxxiii. Indoleacetic acid to creatinine ratio [0219] xxxiv. P-Cresyl sulfate [0220] xxxv. P-Cresyl sulfate to creatinine ratio [0221] xxxvi. P-Cresyl glucuronide [0222] xxxvii. P-Cresyl glucuronide to creatinine ratio [0223] xxxviii. Phenyl sulfate [0224] xxxix. Phenyl sulfate to creatinine ratio [0225] xl. Phenyl glucuronide [0226] xli. Phenyl glucuronide to creatinine ratio [0227] xlii. Phenylacetic acid [0228] xliii. Phenylacetic acid to creatinine ratio [0229] xliv. Phenylacethyl glutamine [0230] xlv. Phenylacethyl glutamine to creatinine ratio [0231] xlvi. Hippuric acid [0232] xlvii. Hippuric acid to creatinine ratio [0233] xlviii. 4-Ethylphenyl sulfate [0234] xlix. 4-Ethylphenyl sulfate to creatinine ratio [0235] l. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid [0236] li. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid to creatinine ratio
[0237] Other uremic toxins associated with cardiovascular disease or chronic kidney disease are also possible. Devices disclosed herein may test for one or more uremic toxins or biomarkers associated with cardiovascular disease or chronic kidney disease using test strips packaged within one or more test cartridges. These test strips target the one or more uremic toxins or biomarkers associated with cardiovascular disease or chronic kidney disease. The test strips may be lateral flow test strips that are antibody or aptamer based. The test strips may also be based on general chemistries.
[0238] Devices disclosed herein may analyze the effluent of patients from dialysis machines for multiple threshold, beneath-threshold, between threshold, and above-threshold concentrations of biomarkers and/or uremic toxins associated with cardiovascular disease or chronic kidney disease. The effluent waste tubing line from a dialysis machine may be extended and routed to above the urine collection sub-system of the device on the toilet described herein, for example. Further, the effluent during dialysis may drain through the waste tubing line from the dialysis machine over the urine collection sub-system. The device may then collect the effluent in the urine collection sub-system and transport the effluent to the analysis sub-system to analyze the effluent. The device described herein may test the effluent with the same or similar process used to test the urine. The biomarkers or uremic toxins associated with cardiovascular disease or chronic kidney disease may include: [0239] i. Albumin [0240] ii. Creatinine [0241] iii. Albumin to creatinine ratio [0242] iv. Cystatin C [0243] v. Cystatin C to creatine ratio [0244] vi. β2-microglobulin [0245] vii. β2-microglobulin to creatinine [0246] viii. Retinol-binding protein (RBP) [0247] ix. Retinol-binding protein (RBP) to creatinine ratio [0248] x. Beta-trace protein [0249] xi. Beta-trace protein to creatinine ratio. [0250] xii. Urea [0251] xiii. Urea to creatinine ratio [0252] xiv. Phosphate [0253] xv. Phosphate to creatinine ratio [0254] xvi. Creatinine [0255] xvii. Parathyroid hormone (PTH) [0256] xviii. Parathyroid hormone to creatinine ratio [0257] xix. Beta 2 microglobulin [0258] xx. Beta 2 microglobulin to creatinine ratio [0259] xxi. Cystatin C [0260] xxii. Cystatin C to creatinine ratio [0261] xxiii. Myoglobin [0262] xxiv. Myoglobin to creatinine ratio [0263] xxv. Kappa free light chains [0264] xxvi. Kappa free light chains to creatinine ratio [0265] xxvii. Complement factor D [0266] xxviii. Complement factor D to creatinine ratio [0267] xxix. Interleukin-6 [0268] xxx. Interleukin-6 to creatinine ratio [0269] xxxi. Alpha 1 microglobulin [0270] xxxii. Alpha 1 microglobulin to creatinine ratio [0271] xxxiii. YKL-40 [0272] xxxiv. YKL-40 to creatinine ratio [0273] xxxv. Lambda free light chains [0274] xxxvi. Lambda free light chains to creatinine ratio [0275] xxxvii. Albumin [0276] xxxviii. Albumin to creatinine ratio Indoxyl sulfate [0277] xxxix. Indoxyl sulfate to creatinine ratio [0278] xl. Indoxyl glucuronide [0279] xli. Indoxyl glucuronide to creatinine ratio [0280] xlii. Indoleacetic acid [0281] xliii. Indoleacetic acid to creatinine ratio [0282] xliv. P-Cresyl sulfate [0283] xlv. P-Cresyl sulfate to creatinine ratio [0284] xlvi. P-Cresyl glucuronide [0285] xlvii. P-Cresyl glucuronide to creatinine ratio [0286] xlviii. Phenyl sulfate [0287] xlix. Phenyl sulfate to creatinine ratio [0288] l. Phenyl glucuronide [0289] li. Phenyl glucuronide to creatinine ratio [0290] lii. Phenylacetic acid [0291] liii. Phenylacetic acid to creatinine ratio [0292] liv. Phenylacethyl glutamine [0293] lv. Phenylacethyl glutamine to creatinine ratio [0294] lvi. Hippuric acid [0295] lvii. Hippuric acid to creatinine ratio [0296] lviii. 4-Ethylphenyl sulfate [0297] lix. 4-Ethylphenyl sulfate to creatinine ratio [0298] lx. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid [0299] lxi. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid to creatinine ratio
[0300] Other biomarkers or uremic toxins associated with cardiovascular disease or chronic kidney disease are also possible. Devices disclosed herein may test for one or more biomarkers or uremic toxins associated with cardiovascular disease or chronic kidney disease using test strips packaged within one or more test cartridges. These test strips target the one or more biomarkers or uremic toxins associated with cardiovascular disease or chronic kidney disease. The test strips may be lateral flow test strips that are antibody or aptamer based. The test strips may also be based on general chemistries.
[0301] The urine collection mechanism of a smart toilet platform device according to example embodiments may be attached to an effluent line from dialysis machines, such as an automated peritoneal dialysis instrument in the home or clinical setting, or a hemodialysis instrument in the clinical setting or home. The urine collection mechanism of a device according to example embodiments will collect the patient's effluent coming out of the effluent line, and send the effluent into the urine analysis sub-system of the device to analyze the effluent for threshold concentrations of biomarkers associated with chronic kidney disease or cardiovascular disease and/or threshold concentrations of uremic toxins associated with chronic kidney disease or cardiovascular disease.
[0302] Alternatively, the urine analysis sub-system of a device according to example embodiments may be in an off-the-toilet architectural configuration and integrated with or by the dialysis machine to test the effluent in the effluent line at or near the dialysis machine.
[0303] For chronic kidney disease and affiliated co-morbidities such as cardiovascular disease, urinary biomarker concentration data, effluent biomarker concentration data, uremic toxin concentration data from the urine or effluent, may be sent by the device into a cloud-based server that clinicians can access. The clinician may use this diagnostic data to remotely or non-remotely optimize the dialysis treatment prescriptions (or other types of treatments) of their chronic kidney disease patients in the home or clinic. In particular, for at-home, automated peritoneal dialysis, some treatment prescription parameters that the clinician may remotely modify include how much fluid volume is sent into the patient, how much fluid volume is pulled out of the patient, number of treatment cycles, or types of fluids.
[0304] Devices disclosed herein may be integrated with a toilet seat that is embedded with sensors for monitoring cardiovascular diseases and heart failure, to collectively monitor for co-morbid chronic conditions, such as chronic kidney disease, diabetes, and/or cardiovascular disease. The toilet seat sensors monitor heart rate, blood pressure, blood oxygenation levels, and the patient's weight and stroke volume. The sensors in the toilet seat may allow for an electrocardiogram, photoplethysmogram, and/or ballistocardiogram.
[0305] Devices disclosed may be attached to a power source that may be re-charged remotely. The remote re-charge may be triggered when the power source runs out of power or when the power-source reaches a threshold of power. The trigger may be performed automatically or manually by a medical staff. The remote connection to the power source may be enabled by_wireless connectivity, Bluetooth connectivity, or other non-wired connectivity.
[0306] Further, the remotely re-charged power source may be made small enough to fit within the device as opposed to act as an external power source to the device. The power source may be remotely turned off when the device is not in use.
[0307] The device may collect anonymized and Health Insurance Portability and Accountability Act (HIPAA)-compliant data of patients. Data of patients may be stored internally or externally (e.g., on a non-transitory, computer-readable medium, such as a hard drive). The data may be incorporated into machine-learning algorithms to predict disease progression and impact of treatment. In particular, monitoring data may be collected to perform predictive diagnostics for urinary tract infections, particularly, but not limited to, diagnosing urinary tract infections in senior-care facilities.