Abstract: Objective To investigate the role of smoking in renal dysfunction and pathological changes in patients with idiopathic membranous nephropathy (IMN). Methods A total of 60 patients with pathological diagnosis of IMN by renal puncture biopsy in the Second Hospital of Jilin University from April 2018 to August 2019 were included. We collected clinical data, laboratory data and pathologic data of these patients, estimated glomerular filtration rate (eGFR), investigated IMN patients with smoking status, and analyzed the smoking status of IMN patients and the relationship between eGFR and pathological indicators. Results Single-factor correlation analysis showed that eGFR was negatively correlated with smoking (r=-0.26, P<0.05), and the total renal interstitial vascular score was positively correlated with smoking (r_s=0.69, P<0.01). Renal tubulointerstitial fibrosis and vascular disease were more severe in smokers, multivariate binary Logistic regression analysis revealed that smoking increased the risk of renal interstitial fibrosis (OR=6.42,P<0.05),vascular wall thickening (OR=4.71,P<0.05) and vitreous degeneration of blood vessels(OR=7.43,P<0.05) in IMN patients.Conclusions Smoking has a certain damage effect on renal function of IMN patients, and is an independent risk factor for renal tubulointerstitial fibrosis, vascular wall thickening and vitreous degeneration of blood vessels in IMN patients.