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.