Hi, frankbj: It is nice case. It appears that your EM specimen was taken from paraffin embedded tissue. But it is good enough to show double contour. This is very convincing evidence of chronic transplant glomerulopathy (chronic active antibody-mediated rejection). Probably this is the reason that your patient has proteinuria.  The photo #4 demonstrates neo-media or neo-intima formation. It indicates that there is concurrent chronic allograft arteriopathy (chronic active T-cell-mediated rejection). The photo #5 exhibits tubular dilatation, which makes me think about more acute tubular injury.  The other interpretation could be tubular atrophy. But the latter are more small sized tubules. What is your thought?

  移植肾慢性移植肾肾病（II级）/慢性排斥反应（中度）（chronic allograft nephroapthy,CAN, grade II/ chronic rejection, moderate, Banff97 Schema, ci2,ct2,cg1,cv1,,mm3,ah0）

部分肾小球呈分叶状；部分肾小球内可见少数淋巴细胞浸润；细小动脉分支管壁局部内膜增生增厚，部分管腔狭窄；肾组织间质基质增生，较多肾小管萎缩，部分肾小管呈轻度代偿性扩张。肾组织间质内可见少数淋巴细胞散在浸润，未见肾小管上皮炎和血管内皮炎等急性排斥反应组织学表现。活检组织电镜观察显示，部分肾小球毛细血管腔扩张，内皮细胞未见增生；肾小球毛细血管基底膜形态基本正常，除个别局部部位外肾小球内未见明显电子致密沉积物；系膜基质节段性轻度至中度增生。

 I notice that you still use Banff 97 schema. Do you have a particular reason?

 病例是一些回顾性病例，所以使用banff 97，谢谢quhong老师提醒！