〔Abstract〕 Objective To investigate the correlation between hyperuricemia and clinical features and Oxford pathology classification of IgA nephropathy on renal biopsy. Methods A retrospective analysis was performed on 289 patients diagnosed of primary IgA nephropathy by renal biopsy. According to the level of uric acid on renal biopsy, the patients were divided into two groups including 120 patients in the high uric acid group and 169 patients in the normal uric acid group. Clinical and histopathological data were collected to analyze the relationship between hyperuricemia and clinical features and Oxford classification on renal biopsy. Results The incidence of hyperuricemia in the 289 patients with IgA nephropathy was 41.5% on renal biopsy. Compared with the normal uric acid group, the high uric acid group had a higher incidence of hypertension. The levels of creatinine, urea nitrogen and 24-hour urinary protein were higher and the lipid metabolisms of triglyceride, cholesterol, high-density lipoprotein and low-density lipoprotein were more abnormal in the high uric acid group. Spearman correlation analysis showed that uric acid was closely related to mesangial proliferation(r=0.254,P<0.000 1), glomerular segmental sclerosis(r=0.145,P=0.013) and tubular atrophy or interstitial fibrosis(r=0.315,P<0.000 1). Multivariate logistic regression showed that hyperuricemia was an independent risk factor for mesangial proliferation and glomerular segmental sclerosis after adjustment of other clinical indicators. Three different models were established based on different clinical indicators. ROC curve combined diagnosis revealed that uric acid could improve the diagnostic ability of mesangial proliferation and glomerular segmental sclerosis. The more combined indicators, the greater the diagnostic efficiency. Conclusion Hyperuricemia is closely related to renal dysfunction and lipid metabolism disorder in IgA nephropathy on renal biopsy. At the same time, hyperuricemia is associated with renal pathological injury. As an independent risk factor for mesangial proliferation and glomerular sclerosis, hyperuricemia can improve the diagnostic value of mesangial proliferation and glomerular sclerosis in IgA nephropathy on renal biopsy.