Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 25 2 2026 02 01 180 191 Fangqian Liang Department of General Practice, North China University of Science and Technology Affiliated Hospital, Tangshan, China Yuyang Yang College of Traditional Chinese Medicine, North China University of Science Technology, Tangshan, China Yao Sun Department of General Practice, North China University of Science and Technology Affiliated Hospital, Tangshan, China Lei Xing Department of General Practice, North China University of Science and Technology Affiliated Hospital, Tangshan, China Xiaolong Yu Department of General Practice, North China University of Science and Technology Affiliated Hospital, Tangshan, China Junzhi Xia Department of General Practice, North China University of Science and Technology Affiliated Hospital, Tangshan, China Jingyuan Gao Department of General Practice, North China University of Science and Technology Affiliated Hospital, Tangshan, China 2025 04 18 2025 07 20 Idiopathic membranous nephropathy (IMN) presents a heterogeneous clinical course, with approximately 30% to 40% of patients experiencing spontaneous remission, while others respond poorly to treatment. This study aims to identify reliable biomarkers for risk stratification in IMN patients. We conducted a prospective observational study involving 187 patients with IMN from February 2022 to February 2024. Patients were categorized into remission and non-remission groups based on clinical outcomes one year post-treatment. Comparative analyses revealed that the non-remission group exhibited significantly higher incidences of hypertension, elevated 24-hour urinary protein, higher serum creatinine levels, and increased inflammatory markers, including the systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune inflammation value (PIV). Conversely, the estimated glomerular filtration rate (eGFR) and lymphocyte-to-monocyte ratio (LMR) were lower in non-remission patients. Spearman correlation identified hypertension, 24-hour urinary protein, and inflammatory indexes as positive correlates with non-remission, while eGFR showed a negative correlation. Multivariate logistic regression confirmed hypertension, high 24-hour urinary protein, SII, SIRI, and PIV as independent risk factors for non-remission; eGFR was a protective factor. Receiver operating characteristic analysis revealed that SII and PIV effectively predicted non-remission (AUC=0.743 and 0.759, respectively). These findings underscore the potential of these indicators in assessing disease severity and guiding personalized treatment strategies. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4419 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4419/2248