Hyperlipidemia in membranous nephropathy

Membranous nephropathy (MN) is a common glomerular disease leading to nephrotic syndrome in adults, clinically characterized by massive proteinuria, hypoalbuminemia, and prominent hyperlipidemia. Growing evidence suggests that hyperlipidemia is not merely a secondary consequence of MN, but may also play a critical role in the pathogenesis and progression of MN. This review specifically focuses on hyperlipidemia in MN-rather than nephrotic dyslipidemia in general-to clarify its distinct mechanisms and implications. We examine the association between hyperlipidemia and MN, elucidating the mechanisms from various perspectives including genetic background, the sPLA2-IB/PLA2R axis, the impact of hyperlipidemia on glomerular podocytes and proximal tubule cells, as well as its modulation of immune function. Therefore, this review aims to critically delineate the specific contributions of hyperlipidemia to MN pathology, distinguishing its active role from passive association, and to evaluate the resulting implications for developing targeted therapeutic interventions.