Next-generation kidney tissue analysis - spatial omics and digital pathology.

Understanding pathological processes is crucial for the diagnosis, prediction and prognostication of kidney diseases. Although progress has been made in non-invasive diagnostic approaches, many pathological processes and diseases mainly manifest in the kidney tissue, necessitating comprehensive analyses of kidney samples. Cellular and molecular analyses of the kidney, including single-cell omics approaches, have identified novel disease mechanisms. However, these non-spatial methods lack information on cellular localization and tissue organization, which is crucial for understanding cell-cell interactions. Such information is particularly important for the kidney, which has many different cell types and intricate architecture. Developments in spatial omics technologies address this challenge by enabling the simultaneous analysis of molecular profiles and spatial context. Advances in three-dimensional imaging technologies, including non-destructive approaches, may provide additional layers of structural information. Integration of spatial omics technologies, such as transcriptomics, epigenomics and metabolomics, with imaging and computational pathology approaches, such as pathomics, has the potential to further advance understanding of the pathophysiology of kidney diseases. In the future, such approaches could become part of the diagnostic workflow in pathology. In the meantime, they hold great promise to aid the identification of diagnostic, prognostic and predictive biomarkers as well as novel therapeutic targets, and thereby facilitate drug discovery.