Correlation of quantitative digital image analysis with the glomerular filtration rate in chronic allograft nephropathy

Am J Transplant. 2004 Feb;4(2):248-56. doi: 10.1046/j.1600-6143.2003.00311.x.


Chronic allograft nephropathy (CAN) is characterized by progressive renal functional loss and histologic abnormalities of one or more tissue compartments. In this study, correlations between histologic abnormalities and graft function [glomerular filtration rate (GFR, measured by iothalamate clearance), serum creatinine (SCr) and urinary protein (UPr)] were investigated using biopsies from 49 patients with newly diagnosed CAN. Extent of tubulointerstitial fibrosis (%TIF), as assessed by a semi-quantitative score, correlated significantly with GFR, SCr and UPr. The close correlation between %TIF and GFR suggested that quantitative measurement of %TIF may predict functional consequences of CAN. Calculation of %TIF by computerized digital analysis was performed using four strategies: (a) quantitation of blue material in Masson's trichrome (MT)-stained sections, (b) quantitation of red material in Sirius Red-stained sections (SR-nonpolarized), (c) quantitation of birefringent material in Sirius Red stained-sections examined under polarized light (SR-polarized) and (d) quantification of brown material in sections stained by immunoperoxidase for alpha-smooth muscle actin. Only the SR-nonpolarized score correlated significantly with GFR at the time of biopsy-diagnosis of CAN. We conclude that digital analysis strategies demonstrate variable accuracy in quantifying %TIF. Validation of the SR-nonpolarized strategy against histologic scoring and GFR supports the application of this technique to longitudinal studies of CAN.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biopsy
  • Coloring Agents
  • Creatinine / blood
  • Glomerular Filtration Rate / physiology*
  • Humans
  • Image Processing, Computer-Assisted
  • Kidney Transplantation / pathology*
  • Kidney Transplantation / physiology
  • Nephritis, Interstitial / pathology*
  • Nephritis, Interstitial / physiopathology
  • Proteinuria
  • Transplantation, Homologous / pathology
  • Transplantation, Homologous / physiology


  • Coloring Agents
  • Creatinine