Low incidence of IgA nephropathy in blacks. The clinical and pathologic features were evaluated in 106 IgA nephropathy patients identified in 1,753 consecutive patients undergoing renal biopsy in the southeastern United States. Special attention was paid to the proportion of Blacks among the IgA nephropathy patients compared with non-IgA nephropathy patients, and any differences in clinical or pathologic findings between Whites and Blacks with IgA nephropathy. The incidence of IgA nephropathy was approximately six times lower in Blacks (6 out of 461) than in Whites (100 out of 1,292) undergoing renal biopsy (P < 0.001). There were no morphologic or immunohistopathologic differences between Whites and Blacks with IgA nephropathy. The only clinical difference was a marked shift in the male to female sex ratio from 3.5:1 in Whites to 1:5 in Blacks (P < 0.004). The low incidence and reversed sex ratio of IgA nephropathy in Blacks were also supported by a review of previously published data