Primary membranous nephropathy (PMN) is one of the common causes of nephrotic syndrome in adults and is characterized by the deposition of immune complexes, resulting in thickening of basement membrane. With the identification of more autoantibodies, the understanding of the pathogenesis of PMN has expanded. Currently, supportive therapy and immunosuppressive therapy are the primary treatments for PMN, which mainly consists of cyclophosphamide, calcineurin inhibitors, rituximab, and so on. With the advent and application of an increasing number of biological agents, a subset of refractory or drug-resistant PMN patients can be effectively treated and achieve remission. This article reviews recent advances in the management of PMN. It covers pretreatment assessment, immunosuppressive therapy, complement- targeted therapy, and anticoagulant therapy and deliberates on the management of rituximab- resistant patients. The review aims to provide clinicians with an up-to-date basis for individualized clinical decision-making.

Primary membranous nephropathy (PMN) is one of the common causes of nephrotic syndrome in adults and is characterized by the deposition of immune complexes, resulting in thickening of basement membrane. With the identification of more autoantibodies, the understanding of the pathogenesis of PMN has expanded. Currently, supportive therapy and immunosuppressive therapy are the primary treatments for PMN, which mainly consists of cyclophosphamide, calcineurin inhibitors, rituximab, and so on. With the advent and application of an increasing number of biological agents, a subset of refractory or drug-resistant PMN patients can be effectively treated and achieve remission. This article reviews recent advances in the management of PMN. It covers pretreatment assessment, immunosuppressive therapy, complement- targeted therapy, and anticoagulant therapy and deliberates on the management of rituximab- resistant patients. The review aims to provide clinicians with an up-to-date basis for individualized clinical decision-making.