Knowledge-structured and evidence-aware semantic self-distillation for glomerular pathology foundation model

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Visual foundation models learn rich pathological morphology but lack explicit concept-level supervision. Vision--language pretraining can provide this supervision but requires costly image--text pairs. Here, we introduce GloSAGE, a semantic self-distillation framework that uses lesion profiles predicted by a pretrained visual teacher to construct structured pathology descriptions. Reliability-guided selection identifies image--text anchors, while Knowledge-Structured Pathology Text Synthesis and Evidence-Guided Negative-pair Construction account for partially observed lesions. Image--text alignment trains projection layers while retaining the frozen visual encoder; an intermediate Semantic Transfer Layer supplies features for downstream tasks. Developed on GloMillion and evaluated across seven glomerulus- and case-level cohorts, GloSAGE supported zero-shot lesion recognition, image--text retrieval, hard-negative discrimination and concept-intervention analyses. It outperformed its source visual model in most lesion-recognition tasks and improved lesion grading, while supporting competitive case-level disease classification, injury grading and baseline renal function estimation. Ablations supported the combined contributions of knowledge-structured text and evidence-guided negatives, and the intermediate transfer layer improved mean lesion-recognition ROC-AUC relative to the complete projection output. A frozen language model conditioned on GloSAGE features generated glomerular descriptions. These findings suggest that teacher-derived lesion profiles can provide annotation-efficient semantic supervision for extending a glomerular visual foundation model.