Triggers, Bullets and Targets, Puzzle of Membranous Nephropathy

INTRODUCTION Idiopathic Membranous Nephropathy (MN) is a common cause of adult nephrotic syndrome. Recently, M-type phospholipase A2 receptor (PLA2-R) has been discovered as the main podocyte antigen in the pathogenesis of idiopathic MN. MATERIALS AND METHODS In this mini review, the author searched English-language MEDLINE for the terms "membranous nephropathy", "rituximab", and "phospholipase A2 receptor" up to October 2011. RESULTS In support of its earlier discovery, reports from China and Europe confirmed the major pathogenic role of non-complement fixing IgG4 antibody against PLA2-R in the pathogenesis of idiopathic MN. Antibodies against aldose reductase (AR) and manganese superoxide dismutase (SOD2 ), and sub-epithelial deposition of cationic bovine serum albumin (BSA) are also reported in rare occasions. It seems that Rituximab is a good therapeutic choice for those patients who need immunosuppressive therapy. CONCLUSIONS Great discoveries in the diagnosis and treatment of idiopathic MN have been performed but pathogenic mechanism and triggers for anti-PLA2-R production are still unknown.