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

ABSTRACT Background Ex vivo confocal microscopy is a real-time technique that provides high-resolution images of fresh, non-fixed tissues, with an optical resolution comparable to conventional pathology. The objective of this study was to investigate the feasibility of using ex vivo confocal microsc...

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Published in:Clinical kidney journal 2023-06, Vol.16 (6), p.1005-1013
Main Authors: Villarreal, Jesús Z, Pérez-Anker, Javiera, Puig, Susana, Xipell, Marc, Espinosa, Gerard, Barnadas, Esther, Larque, Ana B, Malvehy, J, Cervera, Ricard, Pereira, Arturo, Martinez-Pozo, Antonio, Quintana, Luis F, García-Herrera, Adriana
Format: Article
Language:English
Subjects:
Fluorescence microscopy
Medical research
Medicine, Experimental
Original
Type 2 diabetes
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Summary:ABSTRACT Background Ex vivo confocal microscopy is a real-time technique that provides high-resolution images of fresh, non-fixed tissues, with an optical resolution comparable to conventional pathology. The objective of this study was to investigate the feasibility of using ex vivo confocal microscopy in fusion mode (FuCM) and the haematoxylin and eosin (H&E)-like digital staining that results for the analysis of basic patterns of lesion in nephropathology. Methods Forty-eight renal samples were scanned in a fourth-generation ex vivo confocal microscopy device. Samples were subjected to confocal microscopy imaging and were then processed using conventional pathology techniques. Concordance between the techniques was evaluated by means of the percentage of agreement and the κ index. Results Agreement between conventional microscopy and H&E-like digital staining was strong (κ = 0.88) in the evaluation of acute tubular damage and was substantial (κ = 0.79) in the evaluation of interstitial fibrosis, interstitial inflammation, arterial and arteriolar lesions. H&E-like digital staining also allows rapid identification of extracapillary proliferation (κ = 0.88), necrosis and segmental sclerosis (κ = .88) in the glomerular compartment, but the results reported here are limited because of the small number of cases with these glomerular findings. Conclusions FuCM proved to be as effective as conventional techniques in evaluating the presence of acute tubular necrosis and interstitial fibrosis changes, but in fresh tissue. The ease of acquisition of ex vivo confocal microscopy images suggests that FuCM may be useful for rapid evaluation of kidney biopsies and to restructure the clinical workflow in renal histopathology. Lay Summary This study contributes to the refinement of renal biopsy analysis, showing that ex vivo confocal microscopy can become the first step in a hierarchical study and in the segmentation of kidney biopsy studies in renal medicine. Confocal images correlated very well with the corresponding conventional histological sections. This study opens new methods for the global improvement of renal biopsy analysis, thereby favouring the evaluation of new therapies. Graphical Abstract Graphical Abstract
ISSN:2048-8505
2048-8513
DOI:10.1093/ckj/sfad019