Treatment of idiopathic membranous nephropathy: the dilemma of who, when, and how

Membranous nephropathy is the most common histological diagnosis in adult patients with nephrotic syndrome. In most patients no underlying cause for the disease can be identified and the term idiopathic or primary membranous nephropathy is used [lj. It is suspected that idiopathic membranous nephropathy is immunologically mediated and caused by deposition or in situ formation of immune complexes at the epithelial side of the glomerular basement membrane. The trigger for the occurrence of these immune complexes or the antigen (s) involved remain currently unclear [2].