Background: Membranous nephropathy (MN) is the most common cause of the nephrotic syndrome and renal failure in nondiabetic adults. The aim of this study was to evaluate the current diagnostic and therapeutic approaches for the disease.

Materials and Methods: Epidemiology, pathogenesis, etiologies, natural course, differential diagnosis, treatment options, complications and follow up of the disease were all reviewed in this paper.

Results: Most cases of MN are idiopathic, but it can be associated with autoimmune diseases, hepatitis B and C, malignancies, and the use of certain drugs. Spontaneous complete or partial remission of proteinuria occurred in 20 to 40 percent of patients with idiopathic MN. Thus, while almost all patients are candidates of conservative therapies for nephrotic syndrome (eg, angiotensin inhibitors and statins for hyperlipidemia), immunosuppressive therapies include cytotoxic drugs (usually cyclophosphamide) plus glucocorticoids or a calcineurin inhibitor (cyclosporine or tacrolimus) with or without low dose glucocorticoids and ultimately treatment with rituximab should be considered for patients at high risk for a progressive renal failure.

Conclusion: Early diagnosis and appropriate treatment, especially in high risk patients, may decrease the mortality/morbidity rate and renal failure associated with membranous nephropathy.