IgA nephropathy (IgAN), the most common primary glomerular disease, is characterized by hematuria, proteinuria and renal dysfunction, with a subset progressing to end-stage renal disease (ESRD) . This study evaluated the effects of Modified Xiaoji Yinzi (小蓟饮子) on hematuria remission, proteinuria reduction, eGFR decline rate and long-term endpoints in IgAN patients, while assessing predictive accuracy through Kaplan-Meier survival analysis, Cox regression and Random Survival Forest (RSF) models.

A single-center retrospective cohort study enrolled 200 IgAN patients. The treatment group (100 cases) received Modified Xiaoji Yinzi combined with angiotensin converting enzyme inhibitor (ACEI) /angiotensin receptor blocker (ARB) therapy, while the control group (100 cases) received ACEI/ARB alone. All patients received at least 6 months of treatment, with the latest follow-up endpoint being October 31, 2023. Primary outcomes included hematuria remission rate, 24-hour urine protein, estimated glomerular filtration rate (eGFR) decline rate, serum creatinine, urinary albumin-to-creatinine ratio (UACR) and interleukin-6 (IL-6) . Renal endpoints［eGFR decline≥50%, progression to chronic kidney disease (CKD) stages 4～5, dialysis/transplantation］were analyzed via Kaplan-Meier, Cox regression and RSF.

The treatment group exhibited superior hematuria remission rates (80% vs. 55%, P<0.001) and lower 24-hour proteinuria (1.2 vs 1.8 g/24 h, P<0.001) . Slower eGFR decline was observed［-1.2 vs-2.5 mL/ (min·year), P<0.001］. The treatment group demonstrated higher 5-year survival rate (80%vs 58%, P<0.01), with reduced risks of eGFR decline≥50% (18%vs 38%), CKD 4～5 progression (12%vs 32%) and dialysis/transplantation (6%vs 21%) (P<0.01 for all) . Cox regression confirmed Modified Xiaoji Yinzi reduced endpoint risk (HR=0.65, P=0.002) . RSF-enhanced models identified baseline eGFR<60 mL/min, proteinuria>1 g/day, persistent hematuria and elevated IL-6 as the key prognostic predictors.

Modified Xiaoji Yinzi significantly improved hematuria and proteinuria, attenuated eGFR decline and reduced long-term renal endpoint risks in IgAN patients, suggesting durable nephroprotective effects. Integration of RSF with Cox regression further enhanced predictive accuracy for renal endpoints. This study provided novel evidence for integrative IgAN management, warranting validation through multicenter RCTs.