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Anti-PLA2R (phospholipase A2 receptor)
Anti-THSD7A (in some cases)
Other rare or unknown targets in seronegative cases
Membranous nephropathy is a chronic autoimmune kidney disease that causes damage to the glomeruli, the tiny blood vessels in the kidneys that filter waste and excess fluid. This damage leads to protein leaking into the urine (proteinuria), a condition known as nephrotic syndrome.
The disease can be primary (caused by the immune system attacking the kidney directly) or secondary (triggered by infections, cancer, medications, or other autoimmune conditions).
Swelling (edema) in the legs, ankles, feet, or around the eyes
Foamy urine (from protein loss)
Weight gain from fluid retention
Fatigue
High blood pressure
Increased cholesterol levels
Frequent urination, especially at night
In advanced stages, kidney failure
Autoimmune response where the body creates autoantibodies (commonly against the PLA2R protein) on kidney cells.
Infections (e.g., hepatitis B, hepatitis C, syphilis)
Certain medications (e.g., NSAIDs, gold therapy, penicillamine)
Autoimmune diseases (e.g., lupus)
Cancer (e.g., lung, colon, or breast cancer)
Urine tests to detect protein and assess kidney function
Blood tests for kidney function, autoantibodies (e.g., anti-PLA2R)
Kidney biopsy to confirm the diagnosis and severity
Imaging to rule out secondary causes (like tumors or infections)
Supportive care:
Blood pressure control (ACE inhibitors or ARBs)
Diuretics for swelling
Statins for cholesterol
Anticoagulants (if high clot risk)
Immunosuppressive therapy:
Corticosteroids
Cyclophosphamide
Rituximab (a biologic used to reduce autoantibodies)
Treatment is usually based on risk stratification—not all patients need aggressive immunosuppression.
Some people recover on their own (spontaneous remission)
Others need long-term treatment and monitoring
Risk of kidney failure in 10–40% of patients over 5–10 years
Outcomes are improving thanks to newer treatments and personalized risk-based care
Roughly 10 per 100,000 people
Most common cause of nephrotic syndrome in adults
More common in men, typically diagnosed between ages 30 and 60
Kidney Disease: Improving Global Outcomes (KDIGO). (2021). Clinical Practice Guideline for Glomerular Diseases.
Mayo Clinic. (2023). Membranous nephropathy.
https://www.mayoclinic.org/diseases-conditions/membranous-nephropathy
Beck LH, et al. (2009). M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med.
https://doi.org/10.1056/NEJMoa0810457
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