The patient has a long history of "chronic kidney disease". Initially, he did not tell the nephrologist that he started to have kidney disease decades ago. Given the characteristic ultrastructural changes, Alport's syndrome is suggested.

 In the photo #7, there are three platelets in the capillary lumen. I don't know their significance.

 In the photo #7, there are three platelets in the capillary lumen. I don't know their significance.

 Yes, I agree with your observation that there are a lot of foamy cells. The most impressive change is the lamination or splitting of the glomerular basement membrane.

 Here are the additional EM photos with high magnification: