Membranous nephropathy (MN) is a glomerular disease characterized by diffuse thickening of the glomerular basement membrane and subepithelial immune complex deposition. Traditionally MN is diagnosed via renal biopsy pathology. In recent years, the discovery of some target antigens has revolutionized the diagnosis and treatment of MN. Precise typing based on antigen classification has significantly improved diagnostic specificity and prognostic assessment capabilities. Research has confirmed that clinical heterogeneity of different antigens is significant: M-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing 7A (THSD7A) may be associated with the risk of malignancy; neural epidermal growth factor-like 1 (NELL1) is associated with multifactorial pathogenic characteristics; exostosin glycosyltransferase 1/2 (EXT1/2) indicates subtypes of lupus nephritis; while semaphorin 3B (SEMA3B) and neuron-derived neurotrophic factor (NDNF) point to childhood MN and syphilis-related MN, respectively. In terms of treatment, traditional immunosuppressive regimens (such as rituximab) remain the core therapy, but novel targeted therapies (including antibody clearance technology, chimeric antigen receptor T-cell therapy, and immunoadsorption) have shown potential by precisely eliminating pathogenic antibodies or B cells, although their efficacy and safety still require long-term verification. This article systematically reviewed the clinical significance of the antigens spectrum and therapeutic advancements of MN, providing a reference for individualized diagnosis and treatment.