Objective To investigate the pathological characteristics and prognosis of patients with membranous nephropathy with positive neural epidermal growth factor-like 1 protein (nell-1) Methods A total of 183 patients with membranous nephropathy admitted to our hospital from January 2020 to March 2022 were selected. 60 patients with negative M-type phospholipase A2 receptor (PLA2R) were selected as the study subjects through glomerular immunohistochemistry. The expression of nell-1 in the glomeruli of the patients was detected, and the patients were divided into nell-1 negative group and nell-1 positive group. The clinical characteristics of the two groups were compared. The cumulative renal survival rate and cumulative urinary protein remission rate were compared between the two groups by Kaplan-Meier method. Univariate and multivariate Cox regression analysis was used to analyze the factors affecting the renal complex end point and the unremission of urinary protein. Construct the line chart prediction model and evaluate its differentiation, accuracy and effectiveness. Results The positive rate of glomerular nell-1 in 60 patients was 35.00% (21/60). The positive rate of nell-1 was related to age, edema, excessive proteinuria, serum BUN, SUA and eGFR(P＜0.05)The cumulative renal survival rate and cumulative urinary protein remission rate in nell-1 negative group were significantly higher than those in nell-1 positive group (P＜0.05) Age, excessive proteinuria, heterogeneity of electron microscopic subtypes and positive nell-1 were the risk factors of renal complex end point (P＜0.05) Age, hypertension, nephrotic syndrome, excessive proteinuria, pathological stage Ⅱ~Ⅴ, C3 deposition, electron microscopic subtype heterogeneity, renal tubulointerstitial lesions and positive nell-1 were the risk factors of urinary protein unremission (P＜0.05) The discrimination degree of the line chart model is high, and the accuracy and validity are good. Conclusion The positive rate of nell-1 is related to the clinicopathological characteristics of patients with membranous nephropathy, and the cumulative renal survival rate and urinary protein remission rate of patients are low