Objective We intended to get a good understanding of the current role of alkylating agents in the treatment of idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched the Cochrane Library ( Issue 3, 2005), MEDLINE (1978 Jun., 2005) and CBM disc(1978-2005) to get the current best evidence of alkylating agents for treating IMN with NS and further critically appraised the available evidence. Results Alkylating agents showed a significant beneficial effect on complete remission of proteinuria. The treatment of glucocorticoid with cyclophosphamide (MP+CTX) was one of the best managements among the various regimens suggested for IMN, but it was not clear about its long-term effect on renal survival rate. Given the current best evidence together with our clinical experience and the attitudes of the patient and family members, the treatment of (MP+CTX) was administered. There was a significant remission of proteinuria after 6 months follow-up. Conclusions The treatment of (MP+CTX) can significantly improve the remission of proteinuria, however further observations on the long-term effect of alkylating agents on renal survival rate are required.