Abstract: Objective To explore the relationship between perirenal fat thickness (PRAT) and the volume of renal sinus fat (RSF) with estimated glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (UACR) in patients with type 2 diabetes mellitus. Methods A total of 205 patients with type 2 diabetes who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2019 to June 2021 were selected. Their medical history during hospitalization, laboratory examination. Results results, and medical imaging data were retrospective analyzed. Their PRFT, renal area (RA) at renal vein level, the volume of bilateral RSF and renal volume (RV) were measured. The patients were divided into a diabetic kidney disease (DKD) group and a non-DKD group. Both groups were compared for clinical data. The differences of PRFT and RSF were compared among groups with different levels of body mass index (BMI), waist circumference (WC) and metabolic laboratory indexes. Univariate linear regression analysis and multivariate linear regression analysis were used to analyze the independent risk factors of eGFR decline. According to the value of UACR, the patients were divided into a normal group, a microalbuminuria group and a macroalbuminuria group, and general information, laboratory data and perirenal fat indicators were compared among the three groups. The risk factors associated with UACR were investigated by stepwise multiple logistic regression analysis. The value of perirenal fat in predicting the decline of renal function in DKD patients were evaluated. Results The PRFT, RSF, PRFT/RA and RSF/RV of the DKD group were higher than those in the non-DKD group (P<0.05). T2DM patients with overweight or obesity (BMI≥24 kg/m²), central obesity and hyperuricemia showed thicker PRFT and larger RSF. Those with homeostasis model assessment-insulin resistance greater than 2.69 presented thicker PRFT. Linear regression analysis indicated that RSF/RV was independently and negatively correlated with eGFR. According to multiple logistic regression analysis, PRFT≥12.035 mm was an independent risk factor for macroalbuminuria. The ROC curve of RSF/RV in predicting eGFR decline was plotted, with the area under the curve was of 0.738 (P<0.05). Conclusions RSF/RV is independently and negatively correlated with eGFR in patients with type 2 diabetes, which has a certain predictive value for eGFR. PRFT≥12.035 mm is an independent risk factor for macroalbuminuria.