DiagNeXt: A Two-Stage Attention-Guided ConvNeXt Framework for Kidney Pathology Segmentation and Classification

Abstract

Accurate segmentation and classification of kidney pathologies from medical images remain a major challenge in computer-aided diagnosis due to complex morphological variations, small lesion sizes, and severe class imbalance. This study introduces DiagNeXt, a novel two-stage deep learning framework designed to overcome these challenges through an integrated use of attention-enhanced ConvNeXt architectures for both segmentation and classification. In the first stage, DiagNeXt-Seg employs a U-Net-based design incorporating Enhanced Convolutional Blocks (ECBs) with spatial attention gates and Atrous Spatial Pyramid Pooling (ASPP) to achieve precise multi-class kidney segmentation. In the second stage, DiagNeXt-Cls utilizes the segmented regions of interest (ROIs) for pathology classification through a hierarchical multi-resolution strategy enhanced by Context-Aware Feature Fusion (CAFF) and Evidential Deep Learning (EDL) for uncertainty estimation. The main contributions of this work include: (1) enhanced ConvNeXt blocks with large-kernel depthwise convolutions optimized for 3D medical imaging, (2) a boundary-aware compound loss combining Dice, cross-entropy, focal, and distance transform terms to improve segmentation precision, (3) attention-guided skip connections preserving fine-grained spatial details, (4) hierarchical multi-scale feature modeling for robust pathology recognition, and (5) a confidence-modulated classification approach integrating segmentation quality metrics for reliable decision-making. Extensive experiments on a large kidney CT dataset comprising 3847 patients demonstrate that DiagNeXt achieves 98.9% classification accuracy, outperforming state-of-the-art approaches by 6.8%. The framework attains near-perfect AUC scores across all pathology classes (Normal: 1.000, Tumor: 1.000, Cyst: 0.999, Stone: 0.994) while offering clinically interpretable uncertainty maps and attention visualizations. The superior diagnostic accuracy, computational efficiency (6.2x faster inference), and interpretability of DiagNeXt make it a strong candidate for real-world integration into clinical kidney disease diagnosis and treatment planning systems.