Ex vivo confocal microscopy detects basic patterns of acute and chronic lesions using fresh kidney samples

Area of Science:

• Nephropathology
• Medical Imaging
• Histopathology

Background:

• Ex vivo confocal microscopy provides real-time, high-resolution imaging of fresh tissues.
• Its optical resolution is comparable to conventional histopathology.
• This study explores fusion mode confocal microscopy (FuCM) and its H&E-like digital staining for nephropathology.

Purpose of the Study:

• To investigate the feasibility of using FuCM for nephropathology.
• To evaluate H&E-like digital staining for analyzing basic lesion patterns in kidney tissue.
• To compare FuCM findings with conventional histopathology.

Main Methods:

• Forty-eight renal samples were analyzed using a fourth-generation ex vivo confocal microscopy device.
• Samples underwent both FuCM imaging and conventional processing.
• Concordance was assessed using percentage agreement and the kappa index.

Main Results:

• Strong agreement (κ=0.88) was found between H&E-like digital staining and conventional microscopy for acute tubular damage.
• Substantial agreement (κ=0.79) was observed for interstitial fibrosis, inflammation, and vascular lesions.
• FuCM also enabled rapid identification of extracapillary proliferation, necrosis, and segmental sclerosis.

Conclusions:

• FuCM is as effective as conventional techniques for evaluating acute tubular necrosis and interstitial fibrosis in fresh kidney tissue.
• The ease of image acquisition suggests FuCM's utility for rapid kidney biopsy evaluation.
• FuCM has the potential to optimize the workflow in renal histopathology.