Abstract: Objective：To investigate the correlations of urinary sediment features with clinical manifestations and renal pathological changes in IgA nephropathy. Methods：In this prospective study, 365 patients with IgA nephropathy from Department of Nephrology, China-Japan Friendship Hospital during January 2013 and June 2015 were enrolled. The patients were divided into 4 groups according to the numbers of urinary red blood cells and pathological cast in urinary sediments, and 3 groups to the clinical manifestations. The pathological patterns of IgA nephropathy included the active lesions group and the inactive lesions group. Then, the correlations of urinary sediment features with clinical manifestations and renal pathological changes were analyzed. Results：The most common pathological pattern in 365 patients with IgA nephropathy was focal proliferative pattern (302/365, 82.7%), and the next was mild mesangial proliferative pattern (32/365, 8.8%). There were different urinary sediment features in the patients with different clinical manifestations (P=0.013) and between the active lesions group and the inactive lesions group (P＜0.01). Multivariate analysis showed that the change of urinary sediments was the risk factor predicting the active lesions of IgA nephropathy (P＜0.01). Conclusion：Urinary sediment features may partly reflect the clinical manifestations and renal active lesions of IgA nephropathy.