Objective: Healthy volunteers (HVs, n=20) and IMN (n=19) patients were enrolled in the study. The study assessed the serum exosomal miRNA profiles of HVs and patients with IMN using RNA sequencing. To identify exosomal miRNAs for predicting the treatment response, we also analyzed exosomal miRNAs between IMN patients with and without clinical remission. Clinical remission included either complete remission within 1 year after kidney biopsy or partial remission with less than 2.5g of proteinuria for 2 years following pathologic diagnosis. Based on achievement of clinical remission, IMN patients were divided in to two groups [IMN-W (n=9) vs IMN-R (n=10)]. Methods: Compared to HVs, RNA sequencing revealed differential expression of 77 and 44 exosomal miRNAs in patients with IMN-R and IMN-W, respectively. In addition, differential expression of 42 exosomal miRNAs was shown between IMN-R and IMN-W. Among the differentially expressed miRNAs, we identified 4 and 23 miRNAs that were expressed in patients with IMN-W and IMN-R, respectively.  Results: Patients with IMN-R have a distinct exosomal miRNA expression profile compared with HVs and IMN-W. Therefore, circulating exsomal miRNAs could be a surrogate marker for predicting clinical remission of IMN patients during treatment. Conclusions: Objective: Exosomal microRNAs (miRNAs) are potential biomarkers for various renal diseases including glomerular disease. Although circulating anti-phospholipase A2 receptor (PLA2R) antibody can be used for diagnosis, and prognostic assessment of patients with idiopathic membranous nephropathy (IMN), 20-30% of patients will test negative for serum anti-PLA2R antibodies. This study attempted to identify the circulating exosomal miRNA signature predicting the clinical remission in IMN during treatment. Methods: Healthy volunteers (HVs, n=20) and IMN (n=19) patients were enrolled in the study. The study assessed the serum exosomal miRNA profiles of HVs and patients with IMN using RNA sequencing. To identify exosomal miRNAs for predicting the treatment response, we also analyzed exosomal miRNAs between IMN patients with and without clinical remission. Clinical remission included either complete remission within 1 year after kidney biopsy or partial remission with less than 2.5g of proteinuria for 2 years following pathologic diagnosis. Based on achievement of clinical remission, IMN patients were divided in to two groups [IMN-W (n=9) vs IMN-R (n=10)]. Results: Compared to HVs, RNA sequencing revealed differential expression of 77 and 44 exosomal miRNAs in patients with IMN-R and IMN-W, respectively. In addition, differential expression of 42 exosomal miRNAs was shown between IMN-R and IMN-W. Among the differentially expressed miRNAs, we identified 4 and 23 miRNAs that were expressed in patients with IMN-W and IMN-R, respectively.  Conclusions: Patients with IMN-R have a distinct exosomal miRNA expression profile compared with HVs and IMN-W. Therefore, circulating exsomal miRNAs could be a surrogate marker for predicting clinical remission of IMN patients during treatment.