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Deep learning–based molecular morphometrics for kidney biopsies
Marina Zimmermann, Martin Klaus, Milagros N. Wong, Ann-Katrin Thebille, Lukas Gernhold, Christoph Kuppe, Maurice Halder, Jennifer Kranz, Nicola Wanner, Fabian Braun, Sonia Wulf, Thorsten Wiech, Ulf Panzer, Christian F. Krebs, Elion Hoxha, Rafael Kramann, Tobias B. Huber, Stefan Bonn, Victor G. Puelles
Marina Zimmermann, Martin Klaus, Milagros N. Wong, Ann-Katrin Thebille, Lukas Gernhold, Christoph Kuppe, Maurice Halder, Jennifer Kranz, Nicola Wanner, Fabian Braun, Sonia Wulf, Thorsten Wiech, Ulf Panzer, Christian F. Krebs, Elion Hoxha, Rafael Kramann, Tobias B. Huber, Stefan Bonn, Victor G. Puelles
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Resource and Technical Advance Nephrology

Deep learning–based molecular morphometrics for kidney biopsies

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Abstract

Morphologic examination of tissue biopsies is essential for histopathological diagnosis. However, accurate and scalable cellular quantification in human samples remains challenging. Here, we present a deep learning–based approach for antigen-specific cellular morphometrics in human kidney biopsies, which combines indirect immunofluorescence imaging with U-Net–based architectures for image-to-image translation and dual segmentation tasks, achieving human-level accuracy. In the kidney, podocyte loss represents a hallmark of glomerular injury and can be estimated in diagnostic biopsies. Thus, we profiled over 27,000 podocytes from 110 human samples, including patients with antineutrophil cytoplasmic antibody–associated glomerulonephritis (ANCA-GN), an immune-mediated disease with aggressive glomerular damage and irreversible loss of kidney function. We identified previously unknown morphometric signatures of podocyte depletion in patients with ANCA-GN, which allowed patient classification and, in combination with routine clinical tools, showed potential for risk stratification. Our approach enables robust and scalable molecular morphometric analysis of human tissues, yielding deeper biological insights into the human kidney pathophysiology.

Authors

Marina Zimmermann, Martin Klaus, Milagros N. Wong, Ann-Katrin Thebille, Lukas Gernhold, Christoph Kuppe, Maurice Halder, Jennifer Kranz, Nicola Wanner, Fabian Braun, Sonia Wulf, Thorsten Wiech, Ulf Panzer, Christian F. Krebs, Elion Hoxha, Rafael Kramann, Tobias B. Huber, Stefan Bonn, Victor G. Puelles

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Figure 6

Potential role of podometrics for ANCA-GN risk evaluation.

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Potential role of podometrics for ANCA-GN risk evaluation.
(A) Features ...
(A) Features of podocyte depletion correlate with an adapted ANCA-GN score that predicts poor clinical outcomes within 5 years (n = 62 patients for ANCA-GN; Spearman’s rank correlation analyses were performed). (B) Among all 62 ANCA-GN patients, clinical follow-up data identified a total of 8 patients with poor clinical outcomes, including mortality, relapse, and loss of estimated glomerular filtration rate (eGFR) of at least 15% from baseline; these were carefully age- and sex-matched to patients without negative outcomes. (C) Successful age-match with random selection of variable eGFR. (D) Variance in podocyte size per biopsy was significantly elevated in patients with poor outcomes. (E) The ratio between maximal and minimal podocytes sizes (range) per biopsy was also increased in patients with poor outcome. (F) Neither the classical ANCA-GN score nor an adapted ANCA-GN score were different between patients with poor outcome and matched controls. (G) A modified ANCA-GN score based on a ratio between the adapted ANCA-GN score and the range of podocyte size per biopsy was significantly reduced in patients with poor outcome. In C–G, n = 8 ANCA-GN patients with negative outcomes were carefully age- and sex-matched to n = 8 ANCA-GN patients without negative outcomes; Mann-Whitney U tests were performed. Regression lines represent lines of best fit and 95% CI. Each blue dot represents 1 subject. In F, red lines represent medians and IQRs. ANCA-GN, antineutrophil cytoplasmic antibody–associated glomerulonephritis. ****P < 0.0001, ***P < 0.001, **P < 0.01, and *P < 0.05.

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