Abstract: This article reviews the pathogenesis of primary membranous nephropathy (PMN) in recent years, encompassing the latest findings of genetic, antigenic, environmental factors, and intestinal flora, etc., so as to provide a reference for further comprehension of the pathophysiological process and potential therapeutic targets associated with PMN. In terms of genetic factors, the study identifies gene loci associated with the risk and prognosis of PMN, such as phospholipase A2 receptor (PLA2R) and human leukocyte antigen (HLA). Regarding PMN antigens, this paper elaborates on PLA2R, thrombospondin type 1 domain-containing 7A (THSD7A), neutral endopeptidase (NEP), PMN neoantigen, and exogenous antigens in the diagnosis and treatment for membranous nephropathy. In addition, environmental factors such as air pollution, exposure to heavy metals and organic pollutants, and changes in gut microbiota may also be closely related to the incidence of PMN. The findings from this study offer innovative insights for the diagnosis and treatment of PMN.