Objective To investigate the risk factors of renal vascular lesions (RVLs) in IgA nephropathy (IgAN). Methods A total of 100 patients with primary IgAN diagnosed by renal biopsy admitted in Department of Nephrology, Ningxia People’s Hospital from October 2010 to July 2013 were subjected in this study. They were divided into 2 groups: the RVLs group and non-RVLs group. The data of clinical and pathological features in 2 groups were compared and analyzed. Results There were 70 patients (70%) in RVLs group, and 30 (30%) in non-RVLs group. Compared to non-RVLs group, the RVLs group had significantly higher 24-hour urine protein, serum uric acids and serum creatinine (P＜0.05), and obviously lower serum albumin (P＜0.05). Pathological observation indicated that the incidences of glomerular sclerosis, interstitial fibrosis, crescent, interstitial infiltrate, and tubular atrophy were significantly higher in RVLs group than in non-RVLs group (P＜0.05). Multivariate unconditional logistic regression analysis showed that hypertension (OR＝7.728, 95% CI 1.708?34.964), 24-hour urine protein (OR＝20.022, 95% CI 3.869?103.623), glomerulosclerosis (OR＝12.093, 95%CI 2.431?60.149), and renal interstitial fibrosis (OR＝8.511, 95% CI 1.332?54.396) were the factors aggravating RVLs in IgAN patients. Conclusion Hypertension, 24-hour urine protein, glomerulosclerosis and renal interstitial fibrosis are risk factors?for poor prognosis of IgAN, and they are closely associated with?RVLs. The results indicate that RVLs can be regarded as an important pathological prognostic indicator.