Objective To evaluate the efficacy and safety of tacrolimus (TAC) therapy in patients with refractory IgA nephropathy. Methods Nine IgA nephropathy patients were included in this study were treated from Jun. 2008 to Sep. 2013 in Changzheng Hospital of Second Military Medical University. All patients received TAC therapy after the renin-angiotensin system (RAS) blockade therapy and steroid therapy failed. The main outcome was complete or partial remission. Secondary outcomes included the time required to remission, the frequency of recurrence, TAC dosage and adverse events. Results The initial dosage of TAC was (1.89±0.33) mg/d. After treatment with TAC for 6 months, 6 patients achieved complete remission, 2 partial remission and 1 treatment resistance, and most of the remission patients achieved remission during the first 2 months of TAC therapy. The urine protein level of enrolled patients was significantly decreased ([3.05±1.35] g/24 h vs [0.85±1.54] g/24 h, P<0.05) and the serum album level of all patients was significantly improved ([27.00±8.37] g/L vs [37.33±8.08] g/L, P<0.05). One patient receiving TAC therapy presented worsened hypertension, and no other adverse event was observed in this study. Three of 8 proteinuria remission patients had relapses and achieved remission by adjusting the dosages of steroids and tacrolimus. Conclusion TAC can improve proteinuria in patients with refractory IgA nephropathy, with less adverse reactions.