Abstract： Objective:To investigate the correlation between early renal impairment markers in urine and elevated serum homocysteine.Methods:Clinical data of serum homocysteine (Hcy) and early renal injury markers in urine of the health examination population from the Physical Examination Center of Peking University Third Hospital from January 2019 to May 2020 were retrospectively analyzed (1133 cases). The previous medical history, age, sex, blood pressure, body mass index (BMI) of the subjects were collected. Early urine kidney injury markers, including urine microalbumin (U-mALB), urinary N-acetyl-β-D-glucosaminidase (NAG), urinary albumin to creatinine ratio (UACR), and serum renal function, liver function, blood lipid, myocardial enzyme and glycosylated hemoglobin (HbA 1C), etc. were also collected. Those with incomplete previous history, general information, biochemical indexes and decreased estimated glomerular filtration rate (eGFR) were excluded, and 969 cases were included. The included subjects were divided into the normal group (?15 μmol/L) and the elevated group (≥15 μmol/L) according to Hcy levels, the indexes with significant difference between the two groups were included as independent variables, and the multivariate logistic regression was used to explore the influence factors of Hcy elevation. Results:The male ratio, the incidence of increased U-mALB, NAG and UACR were significantly higher in the elevated group than those in the normal Hcy group (93.4% vs 50.6%, 16.4% vs 8.0%, 23.0% vs 14.0%, 13.9% vs 7.9%) (all P<0.05). Systolic blood pressure, diastolic blood pressure, serum uric acid, calcium, alanine aminotransferase (ALT) and lactate dehydrogenase in the elevated group were higher than those in the normal group [(127.5±15.4) vs (121.9±16.2) mmHg (1 mmHg=0.133 kPa), (78.6±9.3) vs (76.0±11.0) mmHg, (385.9±86.0) vs (335.7±88.2) μmol/L, (2.392±0.086) vs (2.366±0.092) mmol/L, (27.8±21.0) vs (23.8±20.2) U/L, (198.3±28.4) vs (192.2±31.2) U/L] (all P<0.05), while high density lipoprotein cholesterol (HDL-C), serum phosphorus were lower than those in the normal group [(1.21±0.25) vs (1.31±0.30) mmol/L, (1.107±0.154) vs (1.158±0.159) mmol/L] (all P<0.05). The increased systolic blood pressure, male, uric acid, U-mALB, NAG were independent correlative factors of Hcy elevation. Conclusion:The increase of Hcy is independently correlated with urine U-mALB and NAG, which suggests that the level of Hcy should be detected as soon as possible in patients with elevated early renal injury markers.