Abstract: Objective To investigate the association between serum uromodulin（UMOD） and hypertensive renal damage. Methods From May 2022 to December 2022, 66 essential hypertensive patients with renal damage, 59 age and gender-matched essential hypertensive patients without renal damage and 58 healthy controls were enrolled in Hebei General Hospital. Serum samples were collected and the levels of UMOD were measured. Multivariate logistic regression analysis was used to analyze the relationship between serum UMOD and renal damage. Results Serum UMOD gradually decreased from healthy individuals to essential hypertensive patients without renal damage to essential hypertensive patients with renal damage （133.18±43.14）,（83.12±20.00）,（69.04±18.68） μg/L, respectively, F=98.395, P＜0.001. Spearman correlation analysis showed that serum UMOD was negatively correlated with creatinine（r_s=-0.411, P＜0.001） and systolic blood pressure（r_s=-0.341, P＜0.001）, and positively correlated with estimated glomerular filtration rate（eGFR）（r_s=0.403, P＜0.001）. After adjusting for confounding factors, multivariate logistic regression analysis showed that the decrease of serum UMOD was an independent risk factor for hypertension（OR=0.927, 95%CI 0.898-0.957）, and an independent risk factor for hypertensive renal damage（OR=0.870, 95%CI 0.813-0.933）, and it was also an independent risk factors for the progression of hypertension to hypertensive renal damage（OR=0.949, 95%CI 0.924-0.975）. Conclusion The decrease of serum UMOD may be one of the risk factors for hypertensive renal damage.