Membranous Nephropathy: Current Understanding in The Light of New Advances

Membranous nephropathy is the most common cause of primary nephrotic syndrome in adults. The most important mechanism in its pathogenesis is loss of immune tolerance. New developments in membranous nephropathy are mostly related to the diagnosis and treatment of the disease, and until recently, the gold standard method in diagnosis was a kidney biopsy. In recent years, many membranous nephropathy-associated antigens and antibodies have been identified. The increased availability of these biomarkers is beneficial in predicting the treatment response, determining the treatment plan, and eliminating the necessity of kidney biopsy in the diagnosis of membranous nephropathy. Because of both the difference in treatment responses and the treatment-related side effects, membranous nephropathy treatment should be individualized. In addition, it is recommended to make a treatment plan by calculating the risk of progressive kidney failure of the disease. Parallel to the changes in diagnosis and follow-up, treatment plans in membranous nephropathy have undergone severe changes in recent years. As the autoimmunity targets in the pathogenesis of the disease become clearer, treatment has turned to more specific therapies that are more selective in targeting antibody-producing cells, such as rituximab. This article described the new developments in the pathogenesis, diagnosis, and treatment of membranous nephropathy.