Membranous nephropathy (MN), the most common cause of adult-onset nephrotic syndrome (NS) in Caucasians, is associated commonly with the secondary complications of hyperlipidemia and hypercoagulability. These may increase the risk for cardiovascular disease, alter the rate of progression of renal disease, and raise the risk for thromboembolic events. The treatment of these secondary effects remains controversial. Although no clear practice guidelines are available to assist the clinician in deciding how and when to start disease-modifying therapies, the literature provides enough information to make reasonable decisions in most clinical scenarios. Prospective trials in the future will provide definitive information on how to best treat these abnormalities.