Management of patients with membranous nephropathy.

Membranous nephropathy (MN) is the most common cause of the nephrotic syndrome in Europe, with an incidence of 5–10/million/year in adults [1]. Although MN can occur secondary to infections, systemic diseases, use of drugs or malignancies, in most patients no underlying cause is identified [idiopathic membranous nephropathy (iMN)]. Recent studies have identified antibodies against the M-type PLA2-receptor, an antigen present on podocytes, in 70% of patients with iMN, thus establishing iMN as an autoimmune disease [2]. These findings were supported by a genome wide association study that found an association between PLA2R and iMN [3]. In this comment, we describe the management of patients with MN (Figure 1).