Objective To explore the diagnostic value of urine protein quantity, urine blood cell morphology analysis and their combination in chronic kidney disease (CKD), and provide guidance for clinical early warning. Methods CKD patients admitted to our hospital from April 2023 to March 2024 were selected as subjects. 126 patients with CKD diagnosed by renal biopsy were selected as CKD group, and 63 patients with non-CKD were selected as non-CKD group. The clinical data of the two groups were compared. Multivariate Logistic regression analysis was used to analyze the factors affecting the occurrence of CKD. Multiple linear regression was used to analyze the relationship between urinary blood cell morphological parameters, 24 h urinary protein and renal function indexes. Restricted cubic splines were used to analyze the dose-response relationship between urinary blood cell morphological parameters, 24 h urinary protein and the risk of CKD. The receiver operating characteristic (ROC) curve was used to evaluate the quantity of urinary protein, the morphological analysis of urine blood cells and the diagnostic efficacy of the combination of the two in the diagnosis of CKD. To compare the coincidence rate of urinary protein quantity and urine blood cell morphological analysis in the diagnosis of CKD type.Results The proportion of hyperlipidemia, blood urea nitrogen (BUN), creatinine (Cr), 24 h urinary protein, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and erythrocyte volume distribution width (RDW) in CKD group were significantly higher than those in non-CKD group, while mean corpuscular hemoglobin content (MCH) and hematocrit (HCT) were significantly lower than those in non-CKD group (P＜0.05). Hyperlipidemia, BUN, Cr, 24 h urinary protein, MCV, MCHC and RDW were risk factors for CKD, while MCH and HCT were protective factors (P＜0.05). There was a non-linear dose-response relationship between hyperlipidemia and CKD (P non linearity＜0.001). Multiple linear regression analysis showed that 24 h urinary protein, MCV, MCHC and RDW were independent risk factors for predicting the increase of BUN and Cr, while MCH and HCT were independent protective factors (P＜0.05). The sensitivity of urine protein quantification, urine blood cell morphology analysis, and their combined diagnosis for CKD were 80.95%, 76.19%, and 95.24%, respectively, with specificity of 84.13%, 82.54%, and 92.06%, accuracy of 82.01%, 78.31%, and 94.18%, respectively. The areas under the ROC curve were 0.762 (0.685～0.812), 0.799 (0.731～0.845), and 0.847 (0.811～0.902), respectively. There was no significant difference in the coincidence rate of urine protein quantity and urine blood cell morphology analysis in the diagnosis of CKD type (χ2=0.184, P=0.668). Conclusion 24-hour urinary protein and morphological parameters of urine blood cells are related to the occurrence of CKD. Quantitative urine protein combined with morphological analysis of urine blood cells can improve the diagnostic efficiency of CKD