IgA nephropathy (IgAN)is the most common glomerular disease and the leading cause of end-stage renal disease (ESRD) in China. About 20% of IgAN patients will progress to ESRD 10 years after the onset. For the unclear causes, a variety of pathogenesis, diversity of clinical pathological manifestations, and heterogeneity of prognosis in IgAN, there is a lack of special treatment up to now. Dietary restrictions, blood pressure control, and RAS inhibition remain the cornerstone management to retard disease progression in IgAN. The use of corticosteroids, immunosuppressants, and tonsillectomy in IgAN remains controversial, and there is a dearth of high quality evidence for clinical decisions. International consensus on this issue is still lacking. The current status of diagnosis and treatment of IgAN will be discussed in this commentary.