Objective To investigate whether adding renal histological score（MEST ⁃ C）to the Kidney Failure Risk Equation（KFRE）could improve predicting the risk of progression in advanced IgA nephropathy. Methods This was a prospective cohort study in which 205 patients with advanced IgA nephropathy［15 ~ 59 mL/ （min·m2 ）］were enrolled and followed up to 2 years. The timepoint of renal biopsy was defined as baseline. The 4⁃variable/8⁃variable KFRE was used to estimate 2⁃year risk of progression to end stage renal disease（ESRD， defined as need for receiving maintenance dialysis or renal transplantation）. AUCs were calculated to evaluate the performance of risk prediction using KFRE and MEST⁃C alone or in combination. Risk classification for progression to ESRD was assessed by net reclassification index（NRI）and integrate discrimination index（IDI）. Results Among 205 patients with advanced IgA nephropathy，38（18.5%）progressed to ESRD within 2 years of follow up. The 4⁃ variable KFRE predicted the progression of advanced IgA nephropathy with an AUC of 0.81（95%CI：0.73 ~ 0.89），while the 8⁃variable KFRE with an AUC of 0.79（95%CI：0.71⁃0.87），the MEST⁃C with an AUC of 0.74 （95%CI：0.64 ~ 0.83）. Adding MEST⁃C to the 4⁃variable KFRE produced an overall AUC of 0.85（95%CI：0.78 ~ 0.91）and significant improvement for risk classification for ESRD（NRI，0.47 and IDI 0.05）. Conclusion Adding renal histological score to the Kidney Failure Risk Equation improved risk prediction and reclassification of progression to ESRD in patients with advanced IgA nephropathy