Thank you for your comment. This is the case of thin basement membrane disease (薄基底膜病). There is mild subendothelial space widening ( I interpret it as chronic ischemic change), which makes GBM look thicker. I measured the thickness of GBM. The average glomerular basement membrane thickness is 218 nm, supporting the diagnosis of thin basement membrane nephropathy, though I routinely use 200 nm as cut-off point (mostly in young patients). In this case, I factored in the patient age and history of hypertension. Therefore, I lower down the threshold.

Your differential diagnosis is nice. The effacement of foot process is patchy, not enough for minimal change disease. I want to see diffuse effacement for that diagnosis. Why is the foot process focally effaced? Honestly, I don't know. If patient has no proteinuria, I ignore it.  IF a patient has proteinuria, I MAY stretch the finding a little bit, suggesting to clinician that this could be unsampled focal segmental glomerulosclerosis (FSGS).  But we have to keep it in mind that FSGS is a diagnosis of exclusion. 

The other differential diagnosis is IgA nephropathy. A negative immunofluorescence and absence of dense deposits rule it out.  Thank you again for your comment.