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Aims: To develop a rule-based decision support system (RDSS) to assist in the diagnosis of glomerular diseases on the basis of clinical, histological and immunohistological findings., Methods: The computer software for the RDSS was written by one of the authors. The prototypical clinical and histomorphological features, including immunofluorescence findings of various glomerular diseases, were selected by three pathologists with experience in renal pathology. For every case included, all the relevant features were fed into the RDSS in the form of one or more vectors. Diagnosis was achieved by the RDSS on the basis of shortest Euclidean distance between the vector of features of a particular 'test' case and vectors of the prototypical features. The diagnoses rendered by the RDSS were compared with the final diagnosis signed out by the renal pathologists; the percentage of correct diagnoses was calculated for the RDSS., Results: A total of 612 cases of glomerular diseases were included in the analysis. The RDSS developed in this study gave the correct diagnosis in 83.2% of the cases included. Of all the cases, membranous glomerulonephritis and lupus nephritis were most frequently diagnosed accurately. However, immunotactoid glomerulonephritis was misdiagnosed due to the lack of ultrastructural findings in the study., Conclusion: The decision support system developed in the present study holds promise, given the high accuracy in diagnosis of glomerular diseases on the basis of clinical, histological and immunofluorescence features. Such a system may prove useful not only for diagnosis but also for postgraduate teaching and self-assessment. Results need to be confirmed in further larger studies.

Acute rejection in renal transplant recipients is diagnosed by renal biopsy at an advanced disease stage. There is no modality for sequential monitoring of graft status. We studied the role of urine cytology in predicting acute cellular rejection (ACR) and its ability to correctly diagnose ACR and differentiate it from drug toxicity (DT). Urine samples from 203 renal transplant recipients were studied to determine the cellular composition using cytology and immunocytochemistry for HLA-DR, intercellular adhesion molecule (ICAM)-1, and interleukin (IL)-2R. In a 3-month follow-up period, there were 36 episodes of graft dysfunction, of which 28 occurred due to ACR and 8 due to DT. The cytology results showed a significantly increased percentage of lymphocytes and polymorphonuclear cells in samples obtained before and during the clinical manifestations of ACR. A greater level of expression of antigens was observed before and during ACR. The use of IL2-R-, ICAM-1-, and HLA class II-specific monoclonal antibodies gave very high specificity, sensitivity, and positive predictive values in diagnosing rejection through urine cytology, suggesting that routine cytology along with immunocytochemistry of urine sediment has clinical potential for early diagnosis and management of ACR and DT. [ABSTRACT FROM AUTHOR]

Current diagnostic modalities for early prostate cancer (PCa) lack sufficient sensitivity and specificity. Magnetic resonance spectroscopic imaging (MRSI) detects biochemical changes in tissues that may predate histological changes that can be diagnosed on a biopsy. Men with MRSI suggestive of malignancy but negative biopsy may thus be harboring cancer that manifests at a later date. We report the first case in our cohort of men with positive MRSI but negative initial biopsy who, 6 years after the initial MRSI, were detected to have PCa despite a "normal" prostate specific antigen (<4.0 ng/ml). [ABSTRACT FROM AUTHOR]