<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 45-year-old man presents to the office with complaints of facial puffiness and mild swelling in his lower back. He denies chest pain, blood in the urine, or fever. He was recently diagnosed with colon cancer. The vital signs include a blood pressure of 12278 mm Hg, a pulse of 76min, a temperature of 36.9C 98.4F, and a respiratory rate of 10min. On physical examination, there is mild facial puffiness that is pitting in nature and presacral edema. His other systemic findings are within normal limits.Urinalysis shows:pH 6.2Color light yellowRBC noneWBC 34HPFProtein 4Cast oval fat bodiesGlucose absentCrystal noneKetone absentNitrite absent 24 hours urine protein excretion 4.8 gA renal biopsy is ordered and diffuse capillary and basement membrane thickening is noted. Which of the following findings is expected to be present if an electron microscopy of the biopsy sample is performed?? A: Basket-weave appearance of GBM, B: Effacement of foot process, C: Subepithelial humps, D: Spike and dome appearance, E: Massive amyloid deposition and spicular aggregates,  <response>: This is a question about membranous nephropathy, which is characterized by subepithelial immune complex deposits along the glomerular basement membrane GBM. The patient has nephrotic syndrome with proteinuria, edema, and hypoalbuminemia. The renal biopsy shows capillary and GBM thickening. On electron microscopy of membranous nephropathy, we would expect to see subepithelial deposits that appear as spikes projecting from the GBM into the urinary space. This gives a spike and dome appearance. Choice A describes the basket weave change of diabetic nephropathy. Choice B is seen in minimal change disease. Choice C describes membranous nephropathy but is not the classic electron microscopic finding. Choice E describes amyloidosis.D: Spike and dome appearance 