Advancing the application of the analytical renal pathology system in allograft IgA nephropathy patients

Abstract

Background

The analytical renal pathology system (ARPS) based on convolutional neural networks has been used successfully in native IgA nephropathy (IgAN) patients. Considering the similarity of pathologic features, we aim to evaluate the performance of the ARPS in allograft IgAN patients and broaden its implementation.

Methods

Biopsy-proven allograft IgAN patients from two different centers were enrolled for internal and external validation. We implemented the ARPS to identify glomerular lesions and intrinsic glomerular cells, and then evaluated its performance. Consistency between the ARPS and pathologists was assessed using intraclass correlation coefficients. The association of digital pathological features with clinical and pathological data was measured. Kaplan-Meier survival curve and cox proportional hazards model were applied to investigate prognosis prediction.

Results

A total of 56 biopsy-proven allograft IgAN patients from the internal center and 17 biopsy-proven allograft IgAN patients from the external center were enrolled in this study. The ARPS was successfully applied to identify the glomerular lesions (F1-score, 0.696–0.959) and quantify intrinsic glomerular cells (F1-score, 0.888–0.968) in allograft IgAN patients rapidly and precisely. Furthermore, the mesangial hypercellularity score was positively correlated with all mesangial metrics provided by ARPS [Spearman’s correlation coefficient (r), 0.439–0.472, and all p values < 0.001]. Besides, a higher allograft survival was noticed among patients in the high-level groups of the maximum and ratio of endothelial cells, as well as the maximum and density of podocytes.

Conclusion

We propose that the ARPS could be implemented in future clinical practice with outstanding capability.

Keywords:

• Deep learning
• allograft IgAN
• glomerular lesion
• intrinsic glomerular cell
• outcome

Acknowledgements

We thank all the participants of this study. The pathological resources for external validation were provided by the First Affiliated Hospital of Zhejiang University.

Statement of Ethics

The study was conducted in strict accordance with the World Medical Association Declaration of Helsinki. The study was approved by the Ethics Committee of Jinling Hospital (2022DZKY-055-01).

Authors’ contributions

XL and CZ conceived and designed the study. XL, DL, and QL collected and digitized all patient cohorts, and carried out statistical analysis. JC and HL compiled pathology data of patients from external center. CZ, FX, SL, DL, and FY participated in analysis and interpretation of the data. XL and HF drafted the manuscript. CZ revised the manuscript. HW, YN, GX, and CZ provided administrative, technical, or material support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Additional information

Funding

This research was funded by the National Natural Science Foundation of China (82070793), and the Medical Scientific Research Project of Jiangsu Provincial Health Commission (ZD2021018).