Objective To evaluate the efficacy and safety of syndrome differentiation-based treatment with traditional Chinese medicine（TCM） and losartan potassium in treating severe IgA nephropathy with liver and kidney yin deficiency syndrome. Methods A prospective multicentered randomize-controlled trial was conducted. A total of156 patients from 5 centers were enrolled from September 2016 to August 2018. They were randomly divided into a treatment group treated with Buyi Ganshen Granules（补益肝肾颗粒） and Losartan Potassium Tablets and a control group treated with Buyi Ganshen Granules simulant and Losartan Potassium Tablets)

with 78 cases in each group.24-hour urinary protein quantity（24 hUpro）

urinary microalbumin/creatinine（MA/Cr）

serum creatinine（SCr）

blood urea nitrogen（BUN）

serum albumin（Alb） and glomerular filtration rate（eGFR）

Hemoglobin（Hb） were detected every 8 weeks. Traditional Chinese medicine（TCM） syndrome scores were determined

for a total of 24 weeks. The efficacy of TCM syndromes and clinical efficacy were evaluated. Results The total effective rate of the treatment group was 70. 67%

which was higher than 38. 57% of the control group（P < 0. 01）. The total effective rate of TCM syndromes in the treatment group was 88. 00%

which was higher than 45. 72% in the control group（P < 0. 01）. Compared with before treatment

24 hUPro

MA/Cr

SCr and BUN were significantly decreased and eGFR was significantly increased in the treatment group at 8

16 and 24 weeks（P < 0. 05 or P < 0. 01）. The control group had a decrease in 24 hUPro

SCr and BUN at 24 weeks of treatment（P < 0. 05）. 24 hUPro

MA/Cr

SCr

BUN in the treatment group was significantly lower than those of the control group at 24 weeks of treatment

and eGFR was significantly higher than that of the control group（P < 0. 05）. Conclusion Combination of TCM syndrome differentiation and losartan potassium could effectively reduce 24 hUPro

MA/Cr

BUN

SCr levels

increase eGFR in patients with severe IgA nephropathy of liver and kidney yin deficiency syndrome

and could improve renal function and delay the progression of IgA nephropathy.