Thank you, geng72. It is very nice case with good clinical information.  The silver stain shows spikes ( am I right?). It seems this is a membranous GN. If patient's ANA is positive (is it right?), lupus nephritis, WHO class V and secondary form of membranous GN associated with autoimmune disorders are on the top of the differential diagnosis. What about IgA, IgM, C1q and C3 results? Especially C1q, which is often positive in lupun nephritis. Do you have EM?

Other secondary form of membranous GN related to medication, infection (hepatitis B), and occult neoplasms also should be considered. If all are excluded, primary form might be the choice. EM may provide some clues.

 感谢QU老师的精彩点评，我忘了把荧光的结果写出来了，免疫荧光：

IgG：阴性        IgM：＋           IgA：阴性        C3：＋＋＋        C1q：＋＋＋

图显示的就是C1q的荧光

这个病例我们的考虑和QU老师相同，它的主要特点是毛细血管襻外观僵硬，基底膜增厚，银染可见钉突样结构，Masson在上皮下可见嗜复红蛋白沉积，但与原发性膜性肾病不同的是:有系膜细胞和基质的增生，有局灶节段性硬化，可见少量新月体形成（没显示出来），间质有以淋巴细胞为主的炎症细胞灶片状浸润，免疫荧光可见C1q的沉积，因临床没有提供如狼疮等确切的自身免疫性疾病的诊断，我们的诊断是：不典型膜性肾病，结合临床，考虑为自身免疫性疾病引起的继发性膜性肾病。

我们的电镜结果要2周后才能出来，如果有新的发现会及时提供给大家。