We aimed to analyze the differential expression of urinary exosome miRNAs in diabetes kidney disease (DKD) patients with dampness-heat syndrome in chronic kidney disease Ⅲ to Ⅳ stage by small RNA sequencing technology. Methods This study was conducted at the First Affiliated Hospital of Anhui University of Chinese Medicine from April 2021 to April 2022. In total, 80 subjects were enrolled, including 40 DKD patients with dampness-heat syndrome and 40 healthy controls. The urinary exosomes of 10 subjects in both groups were selected for miRNA high-throughput sequencing, and selected the differentially expressed miRNAs were selected according to log2(Fold Change) ≥1 and q value < 0. 05. Differentially expressed miRNAs were selected by the following criteria: the mean expression level ( TPM) in at least one group was > 2, log2(fold change) ≥ 2, and at least one sample in the DKD group has TPM> 0 and verified by quantitative RT-PCR. Results By comparing the 80 subjects’ data to the database, 302 miRNAs expressed in healthy controls and 386 miRNAs expressed in DKD patients. In total, 97 differentially expressed miRNAs were screened, in including 84 upregulated and 13 downregulated miRNAs. Of these, 10 miRNAs were selected for verification. RTPCR result showed that the expression levels of miR-664a-5p, miR-320b, and miR-199a-5p were significantly different between the two groups(P<0. 01). The areas under the ROC curve of miR-664a5p, miR-320b, and miR-199a-5p in the diagnosis of dampness-heat syndrome in DKD patients were 0. 886, 0. 923, and 0. 761, respectively. Conclusion We found differences in miRNA expression levels in urinary exosomes between DKD patients with dampness-heat syndrome and controls. The urinary exosome levels of miR-664a-5p, miR-320b, and miR-199a-5p can be used for the diagnosis of DKD patients with dampness-heat syndrome. [ABSTRACT FROM AUTHOR]