Artificial intelligence-powered renal pathology for glomerular disease classification: a systematic review and meta-analysis

Abstract

Abstract Background Diagnostic performance varies across glomerular disease (GD) subtypes, and whether artificial intelligence (AI) outperforms pathologists with different experience levels remains uncertain. Objective To evaluate pathology-based AI models for GD classification and compare their performance with pathologists. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched through 15 July 2026. Studies using pathology images and pathology diagnosis as the reference standard were included. Random-effects models pooled sensitivity, precision, accuracy, F1 score and area under the curve (AUC). Results Fifteen studies comprising 39,536 validation sample units, not necessarily unique patients, were included. For subtypes with at least 10 validation datasets, AI achieved high performance for membranous nephropathy (MN; sensitivity 0.96, precision 0.94, accuracy 0.96, F1 score 0.95, AUC 0.98), IgA nephropathy (IgAN; sensitivity 0.92, precision 0.91, accuracy 0.94, F1 score 0.90, AUC 0.96), and minimal change disease (MCD; sensitivity 0.92, precision 0.87, accuracy 0.96, F1 score 0.89, AUC 1.00). AI also showed higher accuracy than senior pathologists for IgAN, MN, and MCD; however, comparator evidence was sparse and should be interpreted cautiously. Most included studies were retrospective, and substantial heterogeneity was observed across datasets, imaging modalities, model architectures, and validation strategies. Conclusions Pathology-based AI shows strong potential for GD classification, but current head-to-head evidence is insufficient to establish superiority over pathologists, particularly senior pathologists. Prospective multicenter studies integrating multimodal clinical data and standardized external validation are needed.