Pathogenesis of membranous nephropathy: update.

Membranous nephropathy (MN) is the most common cause of adult nephrotic syndrome and it accounts for about 25% of renal biopsies done for this syndrome. Most of the cases are primary or idiopathic in nature while only about one third of the cases are secondary to some known disease.This review describes the recent advances regarding pathogenesis. Membranous nephropathy is an organ specific autoimmune disease. Experimental studies in late 1950s using rat models (Heymann Nephritis) has provided much understanding of pathogenesis of the disease. Role of in situ formation of immune complexes and involvement of complement system was established. Recently the M-type phospholipase A2 receptor (PLA2R) has been identified as target antigen in humans. High titre anti-bovine serum albumin antibodies have been found in children with this disease. It is hoped that in near future non invasive diagnosis and individualised therapy may become a reality.