It was previously believed that IgA nephropathy is a benign glomerular disease. Clinically, it is true that some patients with IgA nephropathy have a very good prognosis, but in recent years, it has been found that some patients with IgA nephropathy have a very poor prognosis, and those with obvious glomerulosclerosis or interstitial fibrosis pathologically have a particularly poor prognosis. It has been reported in the literature that in IgA nephropathy with 20~25 years of follow-up, 25%~30% of the patients eventually need dialysis or kidney transplantation. In China, the survival rate of IgA nephropathy in 10 years and 15 years is 85% and 70.9% respectively. The difference in the prognosis of patients with IgA nephropathy is mainly related to the type of pathology and clinical manifestations. The prognosis of IgA nephropathy is poor if the pathology shows moderate to severe diffuse thylakoid cell proliferation and stromal increase, glomerulosclerosis, crescent formation, tubular atrophy, and fibrosis formation, and the prognosis of IgA nephropathy is good if the pathology only shows mild thylakoid cell proliferation and stromal increase, and the prognosis of IgA nephropathy is good if the renal mesangial, tubular, or blood vessels are not obviously changed. The clinical manifestations of IgA nephropathy vary greatly, proteinuria greater than 3g/24h accounts for 1%~33%, 6%~49% in combination with hypertension, 2%~59% with renal function impairment, and 20%~78% with microscopic hematuria. Clinically, the prognosis of those with massive proteinuria, hypertension or renal impairment is poor. In conclusion, the rate of glomerulosclerosis and the degree of interstitial fibrosis in histology is one of the most important indicators to determine the prognosis of IgA nephropathy; clinical manifestations, such as accompanied by malignant hypertension, high serum creatinine, and large amount of proteinuria is an important indicator to assess the poor prognosis. Clinical combination of pathology is of great significance in evaluating the prognosis of IgA nephropathy.