Membranous nephropathy is one of the most common forms of glomerulonephritis, often quoted as the most significant primary cause of nephrotic syndrome in adults. Recent years have seen highly significant advances in the understanding of the pathogenesis, genetic susceptibility and prognosis of the condition but unfortunately these advances have not been matched by improved evidence about the best forms of treatment. The available randomized clinical trials are heterogeneous but mostly too small and,or with follow-up too short and,or with inappropriate design to answer the key questions to which patients and their physicians need to know the answers. The author previously contributed to the primary literature on the disease but for the last 8 years has been working as a university President and so he has no axe to grind, no conflicts of interest from pharmaceutical consultancies nor any active research programmes and therefore he aims to present impartial analysis of the (unsatisfactory) current situation in relation to this important condition and its treatment.
