Objective To examine the relationship between renal vascular lesions and clinical prognosis in lupus nephritis patients. Methods Renal biopsy specimens and clinical data of 451 patients with lupus nephritis in our hospital from January 1998 to February 2006 were enrolled in this study. According to renal vascular lesions, those patients were classified into six groups: no renal vascular lesion (NVL), immune complex deposits (ICD), lupus vasculopathy (LV),thrombotic microangiopathy (TMA), vasculitis (VAS) and arteriosclerosis (AS). The relationship of renal vascular lesions and the clinical features was retrospectively analyzed. Results (1) In 451 lupus nephritis patients, 247 eases (54.8%) had renal vascular lesion. The incidence of the ICD, LV, TMA, AS and VAS were 8.4%, 9.8%, 6.7%, 29.3% and 0.7%, respectively. (2) The incidence of vascular lesions in IV type lupus nephritis was 69.7%, which was higher than others.(3) Except ICD group, the incidences of renal insufficiency and hypertension were significantlyhigher in vascular lesion groups than those in NVL group (P<0.05). TMA group showed the most severe clinical manifestation, including anemia and depression of platelet. (4) The prognosis of TMAgroup was the worst. The prognosis among other groups was not significantly different.Conclusions Vascular lesions are common in lupus nephritis. TMA patients present not only the most severe clinical manifestation with the poorest prognosis. Other vascular lesions also indicate an elevation of blood pressure and Scr level, but without significant difference in prognosis.