BACKGROUND: This study investigated risk factors and possible mechanisms of arterial and venous thromboembolic events in patients with pMN. METHODS: Patients with pMN confirmed by renal biopsy from June 1, 2010 to March 3, 2023 were included, and the study outcome was set as a composite endpoint of acute coronary syndrome, heart failure, cerebral infarction, arrhythmia, pulmonary embolism, deep venous thrombosis and all-cause mortality. RESULTS: A total of 433 pMN patients with complete data were included, with a median follow-up time of 73 (45.5-101.6) months and a composite endpoint rate of 10.2%. We divided all patients with events into early event group (events occurring in the first 2 years after renal biopsy) and late event group (events occurring after 2 years after renal biopsy) according to the time of event. It showed a lower serum albumin and a higher baseline value of serum PLA2R antibody titer and mean value of each follow-up in the early event group compared with the late event group. Cox proportional hazards model showed that after adjusting for confounding factors, in addition to older age, history of deep vein thrombosis and higher urinary protein, higher baseline serum PLA2R antibody titers (OR 1.034, 95% CI 1.006 -1.063, P = 0.015), and high hsCRP level (OR 1.049, 95% CI 1.002 -1.098, P = 0.041), renal pathology with segmental sclerotic lesions (OR3.480, 95% CI 1.338 -9.050, P = 0.011) were also independent risk factors for the occurrence of endpoint events. The results also showed that baseline serum IL-6 levels were significantly higher in the event group compared with the non-event group (4.25 pg/ml vs. 3.21 pg/ml), and the difference was statistically significant (P = 0.009). CONCLUSIONS: In the early event group, higher serum PLA2R antibody and renal pathology with segmental sclerosis lesions may affect the occurrence of cardiovascular and cerebrovascular events and venous thrombotic events. The inflammatory system may play a role in this relationship.