Membranous nephropathy

Membranous nephropathy (MN) is the most frequent cause of a nephrotic syndrome in nondiabetic adults. The disease is caused when circulating antibodies are deposited on the epithelial side of the glomerular basement membrane. These autoantibodies are directed against antigens that are expressed or deposited on the glomerular podocytes. In 80% of patients with MN the antigen responsible for disease development is phospholipase A2 receptor 1 (PLA2R1). In recent years a large number of other (potential) autoantibodies have been reported, which could be responsible for the development of MN. An antigen-specific diagnosis of MN is important for the differential diagnosis in these patients as the incidence of specific diseases, most importantly tumors, differs greatly depending on the responsible autoantigen. For this reason the identification of the specific antigen influences the differential diagnostics in patients with MN. The PLA2R1 antibody level is important for an individualized treatment management and is highly relevant for the long-term prognosis of patients with MN. The identification of further potential autoantigens in patients with MN enables the implementation of similar ground-breaking developments in the diagnostics and treatment possibilities of MN, also in patients with non-PLA2R1-induced MN. The elucidation of the antigen-specific pathogenesis of MN represents the foundation for the development of novel, more specific curative treatment options.