Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy.

Membranous nephropathy (MN) is the most common cause of nephrotic syndrome among adults, which is the leading glomerular disease that recurs after kidney transplantation. Treatment for MN remained controversial and challenging, partly owing to absence of sensitive and specific biomarkers and effective therapy for prediction and diagnosis of disease activity. MN starts with the formation and deposition of circulating immune complexes on the outer area in the glomerular basement membrane, leading to complement activation. The identification of autoantibodies against the phospholipase A receptor (PLAR) and thrombospondin type-1 domain-containing protein 7A (THSD7A) antigens illuminated a distinct pathophysiological rationale for MN treatments. Nowadays, detection of serum anti-PLAR antibodies and deposited glomerular PLAR antigen can be routinely applied to MN. Anti-PLAR antibodies exhibited much high specificity and sensitivity. Measurement of PLAR in immune complex deposition allows for the diagnosis of PLAR-associated MN in patients with renal biopsies. In the review, we critically summarized newer diagnosis biomarkers including PLAR and THSD7A tests and novel promising therapies by using traditional Chinese medicines such as , , and Astragaloside IV for the treatment of MN patients. We also described unresolved questions and future challenges to reveal the diagnosis and treatments of MN. These unprecedented breakthroughs were quickly translated to clinical diagnosis and management. Considerable advances of detection methods played a critical role in diagnosis and monitoring of treatment.