结合纤维样物质沉积的电镜结果，只可能为淀粉样变性肾病、纤维样肾小球病、免疫触须样肾小球病、纤连蛋白肾病、胶原Ⅲ肾病。

   再进一步排除，考虑为纤维样肾小球病或纤连蛋白肾病。总感觉光镜不太像淀粉样变性肾病。

   不知道免疫荧光和刚果红染色结果如何？纤维大小？

 This is an interesting case with nodular sclerosis appearance. 清静无为  listed all possible differential diagnoses.  I have the same feeling that 总感觉光镜不太像淀粉样变性肾病。 But EM shows fibrillary deposits. All fibrillary GN should be in differential diangosis. Congo red stain will be helpful. Fibrillary size is also important in determining the nature of these fibrils. 

In diabetic nephropathy, the nodular sclerosis may demonstrate diabetic fibrillosis. My experience is that diabetic fibrillosis is often vaguely fibrillary. The above last photo shows well defined fibrils.

Thank you again for this interesting case.

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