非常漂亮的电镜照片，从电镜照片上看病变轻微，光镜及免疫荧光无明显病变，需要考虑的诊断有：

1.薄基底膜病，尽管薄基底膜病常发生在儿童及青年，但也有成人患者的报道，临床主要表现为血尿，本例电镜感觉基底膜有点薄，需要进行测量有无薄基底膜病的可能

2。肾小球微小病变，不支持点，临床主要 以血尿为主，电镜下足突只是局灶性融合，未见弥漫性融合。

3.轻度系膜增生性肾小球肾炎，不支持点，电镜系膜细胞和基质增生不明显，荧光无免疫复合物的沉积

肾小球轻微病变是在实际工作中经常遇到，也是很难诊断的，希望能多得到QU老师指导！

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.

 thin basement membrane disease

学习了。电镜不会看