Objective：To observe the relationship between serum aPLA2Rab titer and the severity of renal disease and renal prognosis in patients with PLA2R-related membranous nephropathy. Methods：A total of 237 patients with PLA2R-related membranous nephropathy confirmed by renal biopsy in the Department of Nephrology of the First Affiliated Hospital of Soochow University were included and were followed up for ≥1 year. The end point was renal insufficiency，defined as a 40% decrease of eGFR from baseline. Clinical indicators of patients were collected for statistical analysis. Results：A total of 273 patients were included in the current study， of which serum aPLA2Rab titer ＜50 RU/mL group(low titer group)had 44 cases，50~＜150 RU/mL group(medium titer group)142 cases and ≥150 RU/mL group(high titer group)87 cases. Serum aPLA2Rab titers were significantly correlated with gender，baseline serum albumin，serum creatinine，total cholesterol，urinary NAG，urinary RBP，and glomerular C4 deposition. Multivariate Cox analysis showed that aPLA2Rab titer was still an independent risk factor for renal insufficiency after correction for clinicopathological parameters. The cutoff point of serum aPLA2Rab titers for predicting renal insufficiency was 135.66 RU/mL，with a sensitivity of 65.8% and a specificity of 63.8%. The renal survival rates without reaching renal insufficiency at 1，5 and 10 years were all 100% in the low titer group；100%， 87.0% and 75.5% in the medium titer group；95.4%，72.3% and 72.3% in the high titer group，respectively；there was a significant difference among the three groups. Conclusion：The current study further confirmed that the serum aPLA2Rab titer level in patients with PLA2R - related membranous nephropathy was related to disease severity and renal prognosis，providing theoretical support for the new concept of immunological remission as the therapeutic target.