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Hoda A Eid,1 Eman M Moazen,1 Manal Elhussini,2 Heba Shoman,3 Asmaa Hassan,4 Asmaa Elsheikh,5 Amr Rezk,4 Ashraf Moursi,3 Moaz Atef,1 Ahmed Kabil1 1Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 2Department of Chest Diseases, Ahmed Maher Teaching Hospital, Cairo, Egypt; 3Internal medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 4Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 5Department of Community and Occupational Medicine, Faculty of Medicine, Al-Azhar University, Cairo, EgyptCorrespondence: Ahmed Kabil, Department of Chest diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt, Tel +201006396601, Email a_ka_81@hotmail.comBackground: Cigarette smoking is an important modifiable risk factor in kidney disease progression. Although long-term smoking has been associated with chronic kidney disease (CKD), its effect on kidney function in early stages has not been clarified.Objective: To detect the early effects of smoking either active or passive on kidney functions.Methodology: The current study was comparative cross sectional study conducted on 280 participants, 140 were non‑smokers and 140 were smokers (70 passive smokers and 70 active smokers). The two groups were comparable in terms of all parameters. We investigated the possible effects of smoking on kidney functions using both serum kidney function tests especially; serum urea, serum creatinine, serum cotinine levels and detection of albumin in urine. Smoking history, full Laboratory investigations, Ventilatory function test including (FEV1/FVC, FEV1, FEF 25– 75%, VC and FVC) were done.Results: Serum urea, serum creatinine, serum cotinine levels and urinary albumin were statistically significant higher in smokers group in comparison to nonsmokers, also the serum cotinine levels and urinary albumin were statistically significant in active smokers in comparison to passive smokers. There were positive correlations between the level of urinary albumin and pack/year (r = 0.9, p< 0.05), smoking index (r = 0.9, p< 0.05), smoking duration (r = 0.4, p< 0.05), and serum cotinine (r = 0.6, p< 0.050) with good statistical significance. The most significant predictive risk factors of microalbuminuria among smokers group in descending orders were active smoking, passive smoking, age and serum cotinine level.Conclusion: Both active and passive smoking, especially among heavy smokers, is a significant risk factor for microalbuminuria. This finding increase the importance of early cessation of smoking in order to minimize early renal affection among healthy smokers that may not be discovered by routine renal function tests.Keywords: active smokers, passive smokers, microalbuminuria, renal function