Objective: This retrospective, multicenter, observational study was conducted using a cohort of patients diagnosed with IgAN through kidney biopsy at three tertiary hospitals. A total of 403 patients who underwent regular check-ups at intervals of at least 6 months were enrolled. Hematuria remission was defined as the presence of hematuria for at least 3 months after biopsy for diagnosis but with no RBC per high-power field observed in the urine under the microscope for at least 2 years thereafter. Methods: The mean annual rate of eGFR decline was lower in the remission of hematuria group than in the persistent hematuria group (-1.51 ± 2.86 vs. -2.60 ± 3.18 mL/min/1.73 m2/year, p = 0.002). In the remission of hematuria group, the mean annual rate of eGFR decline decreased after hematuria disappearance (from -1.28 ± 7.06 to 0.09 ± 0.29 mL/min/1.73 m2/year, p = 0.016). Multivariable analysis revealed remission of hematuria as an independent predictor of a 50% reduction in kidney function (HR, 0.55; 95% CI, 0.33 to 0.99). Renal survival, defined as a 50% reduction in kidney function, was better in the remission of hematuria group than in the persistent hematuria group (p = 0.030). When renal survival was defined by the absence of ESRD, it was not significantly different between the two groups (p = 0.079). Results: In this study, which used the stricter definition of hematuria remission than that used in previous studies, patients with remission of hematuria showed favorable kidney prognosis. Conclusions: Objective: Recent studies have shown that remission of hematuria is associated with favorable clinical outcomes in patients with immunoglobulin A nephropathy (IgAN). The current study was conducted to compare the long-term clinical outcomes between patients with remission of hematuria and those with persistent hematuria using the stricter definition of "remission of hematuria" than that used in previous studies. Methods: This retrospective, multicenter, observational study was conducted using a cohort of patients diagnosed with IgAN through kidney biopsy at three tertiary hospitals. A total of 403 patients who underwent regular check-ups at intervals of at least 6 months were enrolled. Hematuria remission was defined as the presence of hematuria for at least 3 months after biopsy for diagnosis but with no RBC per high-power field observed in the urine under the microscope for at least 2 years thereafter. Results: The mean annual rate of eGFR decline was lower in the remission of hematuria group than in the persistent hematuria group (-1.51 ± 2.86 vs. -2.60 ± 3.18 mL/min/1.73 m2/year, p = 0.002). In the remission of hematuria group, the mean annual rate of eGFR decline decreased after hematuria disappearance (from -1.28 ± 7.06 to 0.09 ± 0.29 mL/min/1.73 m2/year, p = 0.016). Multivariable analysis revealed remission of hematuria as an independent predictor of a 50% reduction in kidney function (HR, 0.55; 95% CI, 0.33 to 0.99). Renal survival, defined as a 50% reduction in kidney function, was better in the remission of hematuria group than in the persistent hematuria group (p = 0.030). When renal survival was defined by the absence of ESRD, it was not significantly different between the two groups (p = 0.079). Conclusions: In this study, which used the stricter definition of hematuria remission than that used in previous studies, patients with remission of hematuria showed favorable kidney prognosis.