Membranous Nephropathy
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Raja Ramachandran Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Vivekanand Jha George Institute for Global Health, New Delhi, India

Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India

School of Public Health, Imperial College, London, United Kingdom

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  • 1.

    Sethi S: Membranous nephropathy: A single disease or a pattern of injury resulting from different diseases. Clin Kidney J 14: 21662169, 2021 10.1093/ckj/sfab069 PubMed

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  • 2.

    Sethi S, Beck LH, Glassock RJ, Haas M, De Vriese AS, Caza TN, et al.: Mayo Clinic consensus report on membranous nephropathy: Proposal for a novel classification. Mayo Clin Proc 98: 16711684, 2023 10.1016/j.mayocp.2023.08.006 PubMed

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  • 3.

    Moroni G, Ponticelli C: Secondary membranous nephropathy. A narrative review. Front Med (Lausanne) 7: 611317, 2020 10.3389/fmed.2020.611317 PubMed

  • 4.

    Rihova Z, Honsova E, Merta M, Jancova E, Rysava R, Reiterova J, et al.: Secondary membranous nephropathy–One center experience. Ren Fail 27: 397402, 2005 10.1081/JDI-65304 PubMed

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  • 5.

    Hladunewich MA, Troyanov S, Calafati J, Cattran DC, Metropolitan Toronto Glomerulonephritis Registry: The natural history of the non-nephrotic membranous nephropathy patient. Clin J Am Soc Nephrol 4: 14171422, 2009 10.2215/CJN.01330209 PubMed

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  • 6.

    Barbour SJ, Fervenza FC, Induruwage D, Brenchley PE, Rovin B, Hladunewich MA, et al.; MENTOR Trial Investigators: Anti-PLA2R antibody levels and clinical risk factors for treatment nonresponse in membranous nephropathy. Clin J Am Soc Nephrol 18: 12831293, 2023 10.2215/CJN.0000000000000237 PubMed

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  • 7.

    Bobart SA, Han H, Tehranian S, De Vriese AS, Roman JCL, Sethi S, et al.: Noninvasive diagnosis of PLA2R-associated membranous nephropathy: A validation study. Clin J Am Soc Nephrol 16: 18331839, 2021 10.2215/CJN.05480421 PubMed

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  • 8.

    De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC: A proposal for a serology-based approach to membranous nephropathy. J Am Soc Nephrol 28: 421430, 2017 10.1681/ASN.2016070776 PubMed

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  • 9.

    Ravindran A, Madden B, Charlesworth MC, Sharma R, Sethi A, Debiec H, et al.: Proteomic analysis of complement proteins in membranous nephropathy. Kidney Int Rep 5: 618626, 2020 10.1016/j.ekir.2020.01.018 PubMed

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  • 10.

    Bobart SA, De Vriese AS, Pawar AS, Zand L, Sethi S, Giesen C, et al.: Noninvasive diagnosis of primary membranous nephropathy using phospholipase A2 receptor antibodies. Kidney Int 95: 429438, 2019 10.1016/j.kint.2018.10.021 PubMed

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  • 11.

    Xu X, Wang G, Chen N, Lu T, Nie S, Xu G, et al.: Long-term exposure to air pollution and increased risk of membranous nephropathy in China. J Am Soc Nephrol 27: 37393746, 2016 10.1681/ASN.2016010093 PubMed

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  • 12.

    Zhang XD, Cui Z, Zhao MH: The genetic and environmental factors of primary membranous nephropathy: An overview from China. Kidney Dis (Basel) 4: 6573, 2018 10.1159/000487136 PubMed

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  • 13.

    Stanescu HC, Arcos-Burgos M, Medlar A, Bockenhauer D, Kottgen A, Dragomirescu L, et al.: Risk HLA-DQA1 and PLA(2)R1 alleles in idiopathic membranous nephropathy. N Engl J Med 364: 616626, 2011 10.1056/NEJMoa1009742 PubMed

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  • 14.

    Xie J, Liu L, Mladkova N, Li Y, Ren H, Wang W, et al.: The genetic architecture of membranous nephropathy and its potential to improve non-invasive diagnosis. Nat Commun 11: 1600, 2020 10.1038/s41467-020-15383-w PubMed

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  • 15.

    Gupta S, Köttgen A, Hoxha E, Brenchley P, Bockenhauer D, Stanescu HC, et al.: Genetics of membranous nephropathy. Nephrol Dial Transplant 33: 14931502, 2018 10.1093/ndt/gfx296 PubMed

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  • 16.

    Hu X, Xu J, Wang W, Liu L, Jing Y, Gao C, et al.: Combined serologic and genetic risk score and prognostication of phospholipase A2 receptor-associated membranous nephropathy. Clin J Am Soc Nephrol 19: 573582, 2024 10.2215/CJN.0000000000000422 PubMed

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  • 17.

    Kurien AA, Prema Ks J, Walker PD, Caza TN: Traditional indigenous medicines are an etiologic consideration for NELL1-positive membranous nephropathy. Kidney Int 102: 14241426, 2022 10.1016/j.kint.2022.09.001 PubMed

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  • 18.

    Efe O, So PNH, Anandh U, Lerma EV, Wiegley N: An updated review of membranous nephropathy. Indian J Nephrol 34: 105118, 2024 10.25259/ijn_317_23 PubMed

  • 19.

    Spain RI, Andeen NK, Gibson PC, Samuels MH, Morris CD, Solomon AJ, et al.: Lipoic acid supplementation associated with neural epidermal growth factor-like 1 (NELL1)-associated membranous nephropathy. Kidney Int 100: 12081213, 2021 10.1016/j.kint.2021.10.010 PubMed

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  • 20.

    Avasare RS, Clark S, Spain RI, Wusirika R, Rope R, Gurley S, et al.: Characteristics and outcomes of NELL1 membranous nephropathy in lipoic acid users and nonusers. Kidney Int Rep 9: 13791386, 2024 10.1016/j.ekir.2024.02.1401 PubMed

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  • 21.

    Kaur P, Prabhahar A, Kumar A, Pal D, Kumar V, Sekar A, et al.: Complementary medicine and phospholipase A2 receptor (PLA2R)-related membranous nephropathy—Fortuitous or causal? Kidney Int 103: 425427, 2023 10.1016/j.kint.2022.11.008 PubMed

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  • 22.

    Narayanan R, Sivadas S, Kurien AA: NELL-1-associated membranous nephropathy linked to skin fairness cream use: Insights from an Indian case series. Kidney Int 105: 13161319, 2024 10.1016/j.kint.2024.03.025 PubMed

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  • 23.

    Meena P, Jha V: The unfairness of fairness creams: Unveiling the toxic impact on kidneys of mercury in beauty products. Kidney Int 106: 337340, 2024 10.1016/j.kint.2024.06.014 PubMed

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  • 24.

    Caza TN, Hassen SI, Dvanajscak Z, Kuperman M, Edmondson R, Herzog C, et al.: NELL1 is a target antigen in malignancy-associated membranous nephropathy. Kidney Int 99: 967976, 2021 10.1016/j.kint.2020.07.039 PubMed

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  • 25.

    Kaur PP, Niranjan AV, Kumar V, Pal D, Rathi M, Kohli HS, et al.: Viral infection associated membranous nephropathy: Clinical presentation and outcomes. Indian J Nephrol 35: 7076, 2025 10.25259/IJN_57_2024 PubMed

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  • 26.

    Beck LH, Bonegio RGB, Lambeau G, Beck DM, Powell DW, Cummins TD, et al.: M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med 361: 1121, 2009 10.1056/NEJMoa0810457 PubMed

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  • 27.

    Heymann W, Hackel DB, Harwood S, Wilson SG, Hunter JL: Production of nephrotic syndrome in rats by Freund’s adjuvants and rat kidney suspensions. Proc Soc Exp Biol Med 100: 660664, 2009 10.3181/00379727-100-24736 PubMed

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  • 28.

    Meyer-Schwesinger C, Tomas NM, Dehde S, Seifert L, Hermans-Borgmeyer I, Wiech T, et al.: A novel mouse model of phospholipase A2 receptor 1-associated membranous nephropathy mimics podocyte injury in patients. Kidney Int 97: 913919, 2020 10.1016/j.kint.2019.10.022 PubMed

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  • 29.

    Reinhard L, Wiech T, Reitmeier A, Lassé M, Machalitza M, Heumann A, et al.: Pathogenicity of human Anti-PLA 2 R1 antibodies in minipigs: A pilot study. J Am Soc Nephrol 34: 369373, 2023 10.1681/ASN.0000000000000068 PubMed

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  • 30.

    Tomas NM, Dehde S, Meyer-Schwesinger C, Huang M, Hermans-Borgmeyer I, Maybaum J, et al.: Podocyte expression of human phospholipase A2 receptor 1 causes immune-mediated membranous nephropathy in mice. Kidney Int 103: 297303, 2023 10.1016/j.kint.2022.09.008 PubMed

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  • 31.

    Akiyama S, Akiyama M, Imai E, Ozaki T, Matsuo S, Maruyama S: Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy. Clin Exp Nephrol 19: 653660, 2015 10.1007/s10157-014-1054-2 PubMed

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  • 32.

    Ramachandran R, Kumar V, Kumar A, Yadav AK, Nada R, Kumar H, et al.: PLA2R antibodies, glomerular PLA2R deposits and variations in PLA2R1 and HLA-DQA1 genes in primary membranous nephropathy in South Asians. Nephrol Dial Transplant 31: 14861493, 2016 10.1093/ndt/gfv399 PubMed

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  • 33.

    Tomas NM, Beck LH, Meyer-Schwesinger C, Seitz-Polski B, Ma H, Zahner G, et al.: Thrombospondin type-1 domain-containing 7A in idiopathic membranous nephropathy. N Engl J Med 371: 22772287, 2014 10.1056/NEJMoa1409354 PubMed

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  • 34.

    Sethi S, Madden BJ, Debiec H, Charlesworth MC, Gross LANN, Ravindran A, et al.: Exostosin 1/exostosin 2-associated membranous nephropathy. J Am Soc Nephrol 30: 11231136, 2019 10.1681/ASN.2018080852 PubMed

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  • 35.

    Sethi S, Debiec H, Madden B, Charlesworth MC, Morelle J, Gross LANN, et al.: Neural epidermal growth factor-like 1 protein (NELL-1) associated membranous nephropathy. Kidney Int 97: 163174, 2020 10.1016/j.kint.2019.09.014 PubMed

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  • 36.

    Sethi S, Debiec H, Madden B, Vivarelli M, Charlesworth MC, Ravindran A, et al.: Semaphorin 3B-associated membranous nephropathy is a distinct type of disease predominantly present in pediatric patients. Kidney Int 98: 12531264, 2020 10.1016/j.kint.2020.05.030 PubMed

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  • 37.

    Sethi S, Madden B, Debiec H, Morelle J, Charlesworth MC, Gross LANN, et al.: Protocadherin 7-associated membranous nephropathy. J Am Soc Nephrol 32: 12491261, 2021 10.1681/ASN.2020081165 PubMed

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  • 38.

    Al-Rabadi LF, Caza T, Trivin-Avillach C, Rodan AR, Andeen N, Hayashi N, et al.: Serine protease HTRA1 as a novel target antigen in primary membranous nephropathy. J Am Soc Nephrol 32: 16661681, 2021 10.1681/ASN.2020101395 PubMed

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  • 39.

    Le Quintrec M, Teisseyre M, Bec N, Delmont E, Szwarc I, Perrochia H, et al.: Contactin-1 is a novel target antigen in membranous nephropathy associated with chronic inflammatory demyelinating polyneuropathy. Kidney Int 100: 12401249, 2021 10.1016/j.kint.2021.08.014 PubMed

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  • 40.

    Caza TN, Storey AJ, Hassen SI, Herzog C, Edmondson RD, Arthur JM, et al.: Discovery of seven novel putative antigens in membranous nephropathy and membranous lupus nephritis identified by mass spectrometry. Kidney Int 103: 593606, 2023 10.1016/j.kint.2023.01.001 PubMed

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  • 41.

    Teisseyre M, Beyze A, Perrochia H, Szwarc I, Bourgeois A, Champion C, et al.: C5b-9 glomerular deposits are associated with poor renal survival in membranous nephropathy. Kidney Int Rep 8: 103114, 2023 10.1016/j.ekir.2022.10.008 PubMed

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  • 42.

    Seifert L, Zahner G, Meyer-Schwesinger C, Hickstein N, Dehde S, Wulf S, et al.: The classical pathway triggers pathogenic complement activation in membranous nephropathy. Nat Commun 14: 473, 2023 10.1038/s41467-023-36068-0 PubMed

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  • 43.

    Rosenzwajg M, Languille E, Debiec H, Hygino J, Dahan K, Simon T, et al.: B- and T-cell subpopulations in patients with severe idiopathic membranous nephropathy may predict an early response to rituximab. Kidney Int 92: 227237, 2017 10.1016/j.kint.2017.01.012 PubMed

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  • 44.

    Ramachandran R, Kaundal U, Girimaji N, Rakha A, Rathi M, Gupta KL, et al.: Regulatory B cells are reduced and correlate with disease activity in primary membranous nephropathy. Kidney Int Rep 5: 872878, 2020 10.1016/j.ekir.2020.03.023 PubMed

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  • 45.

    Hoxha E, Reinhard L, Castedello T, Becker JU: False positivity for PLA(2)R1 antibody measured by ELISA in a nephrotic patient with no membranous nephropathy. Kidney Int 103: 411415, 2023 10.1016/j.kint.2022.09.011 PubMed

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  • 46.

    Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM, et al.: KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int 100: S1S276, 2021 10.1016/j.kint.2021.05.021 PubMed

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  • 47.

    Li X, Shen Y, Li Y, Ma L, Sun Q: Clinicopathological characteristics and outcomes of PLA2R related idiopathic membranous nephropathy in patients with seronegative PLA2R antibodies. Ren Fail 46: 2297015, 2024 10.1080/0886022X.2023.2297015 PubMed

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  • 48.

    Du Y, Li J, He F, Lv Y, Liu W, Wu P, et al.: The diagnosis accuracy of PLA2R-AB in the diagnosis of idiopathic membranous nephropathy: A meta-analysis. PLoS One 9: e104936, 2014 10.1371/journal.pone.0104936 PubMed

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  • 49.

    Wiech T, Stahl RAK, Hoxha E: Diagnostic role of renal biopsy in PLA(2)R1-antibody-positive patients with nephrotic syndrome. Mod Pathol 32: 13201328, 2019 10.1038/s41379-019-0267-z PubMed

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  • 50.

    Pourcine F, Dahan K, Mihout F, Cachanado M, Brocheriou I, Debiec H, et al.: Prognostic value of PLA2R autoimmunity detected by measurement of anti-PLA2R antibodies combined with detection of PLA2R antigen in membranous nephropathy: A single-centre study over 14 years. PLoS One 12: e0173201, 2017 10.1371/journal.pone.0173201 PubMed

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  • 51.

    Stefan G, Stancu S, Zugravu A, Popa O, Zubidat D, Petre N, et al.: Negative anti-phospholipase A2 receptor antibody status at three months predicts remission in primary membranous nephropathy. Ren Fail 44: 258268, 2022 10.1080/0886022X.2022.2033265 PubMed

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  • 52.

    Hofstra JM, Branten AJ, Wirtz JJ, Noordzij TC, du Buf-Vereijken PW, Wetzels JF: Early versus late start of immunosuppressive therapy in idiopathic membranous nephropathy: a randomized controlled trial. Nephrol Dial Transplant 25:129136, 201010.1093/ndt/gfp390 PubMed

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  • 53.

    van de Logt A-E, Dahan K, Rousseau A, van der Molen R, Debiec H, Ronco P, et al.: Immunological remission in PLA2R-antibody-associated membranous nephropathy: Cyclophosphamide versus rituximab. Kidney Int 93: 10161017, 2018 10.1016/j.kint.2017.12.019 PubMed

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  • 54.

    Ramachandran R, Yadav AK, Kumar V, Inamdar N, Nada R, Gupta KL, et al.: Temporal association between PLA2R antibodies and clinical outcomes in primary membranous nephropathy. Kidney Int Rep 3: 142147, 2018 10.1016/j.ekir.2017.09.001 PubMed

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  • 55.

    Seitz-Polski B, Debiec H, Rousseau A, Dahan K, Zaghrini C, Payré C, et al.: Phospholipase A2 receptor 1 epitope spreading at baseline predicts reduced likelihood of remission of membranous nephropathy. J Am Soc Nephrol 29: 401408, 2018 10.1681/ASN.2017070734 PubMed

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    Reinhard L, Zahner G, Menzel S, Koch-Nolte F, Stahl RAK, Hoxha E: Clinical relevance of domain-specific phospholipase A(2) receptor 1 antibody levels in patients with membranous nephropathy. J Am Soc Nephrol 31: 197207, 2020 10.1681/ASN.2019030273 PubMed

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    Ruggenenti P, Reinhard L, Ruggiero B, Perna A, Perico L, Peracchi T, et al.: Anti-phospholipase A2 receptor 1 and anti-cysteine rich antibodies, domain recognition and rituximab efficacy in membranous nephropathy: A prospective cohort study. Am J Kidney Dis 83: 588600.e1, 2024 10.1053/j.ajkd.2023.10.013 PubMed

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    Rodas LM, Matas-García A, Barros X, Blasco M, Viñas O, Llobell A, et al.: Antiphospholipase 2 receptor antibody levels to predict complete spontaneous remission in primary membranous nephropathy. Clin Kidney J 12: 3641, 2019 10.1093/ckj/sfy005 PubMed

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    Chertow GM, Heerspink HL, Mark PB, Dwyer JP, Nowicki M, Wheeler DC, et al.: Effects of dapagliflozin in patients with membranous nephropathy. Glomerular Dis 4: 137145, 2024 10.1159/000539770 PubMed

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    Narayanasami S, Vijayakumar NA, Trivedi M, Sekar A, Sulaiman S, Nayak S, et al.: Clinical characteristics and outcomes of neural epidermal growth factor-like 1 protein-associated membranous nephropathy. Kidney Int Rep 9: 15131516, 2024 10.1016/j.ekir.2024.02.1405 PubMed

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    Ponticelli C, Altieri P, Scolari F, Passerini P, Roccatello D, Cesana B, et al.: A randomized study comparing methylprednisolone plus chlorambucil versus methylprednisolone plus cyclophosphamide in idiopathic membranous nephropathy. J Am Soc Nephrol 9: 444450, 1998 10.1681/ASN.V93444 PubMed

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    Du Buf-Vereijken PWG, Feith GW, Hollander D, Gerlag PGG, Wirtz JJJM, Noordzij TC, et al.; Membranous Nephropathy Study Group: Restrictive use of immunosuppressive treatment in patients with idiopathic membranous nephropathy: High renal survival in a large patient cohort. QJM 97: 353360, 2004 10.1093/qjmed/hch059 PubMed

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    van den Brand JA, van Dijk PR, Hofstra JM, Wetzels JF: Cancer risk after cyclophosphamide treatment in idiopathic membranous nephropathy. Clin J Am Soc Nephrol 9: 10661073, 2014 10.2215/CJN.08880813 PubMed

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    Praga M, Barrio V, Juarez GF, Luno J, Grupo Espanol de Estudio de la Nefropatia Membranoso: Tacrolimus monotherapy in membranous nephropathy: A randomized controlled trial. Kidney Int 71: 924930, 2007 10.1038/sj.ki.5002215 PubMed

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    Ramachandran R, Hn HK, Kumar V, Nada R, Yadav AK, Goyal A, et al.: Tacrolimus combined with corticosteroids versus Modified Ponticelli regimen in treatment of idiopathic membranous nephropathy: Randomized control trial. Nephrology (Carlton) 21: 139146, 2016 10.1111/nep.12569 PubMed

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    Ramachandran R, Yadav AK, Kumar V, Siva Tez Pinnamaneni V, Nada R, Ghosh R, et al.: Two-year follow-up study of membranous nephropathy treated with tacrolimus and corticosteroids versus cyclical corticosteroids and cyclophosphamide. Kidney Int Rep 2: 610616, 2017 10.1016/j.ekir.2017.02.004 PubMed

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