Background: Hypertension (HTN) is one of the most important causes of chronic kidney disease (CKD) and may also be the presenting feature of asymptomatic primary renal disease. However, a progressive reduction in estimated glomerular filtration rate (eGFR) and increased albuminuria indicate progressive loss of renal function, an alteration of renal function is an insensitive marker of renal impairment because a major reduction in renal function is needed before serum creatinine rise. Low-grade inflammation plays crucial pathophysiological role in both hypertension and CKD. Objective: This work was aimed to study neutrophil-to-lymphocyte ratio (NLR) as a marker for early detection of hypertensive kidney disease and as a predictor of worsening renal function in patients with high normal blood pressure and in hypertensive patients. Patient and methods: This case control study included a total of 125 hypertensive patients and 50 subjects with normal blood pressure, attending at Department of Internal Medicine, Banha University Hospital. All participants were subjected to careful history taking, clinical examination, and laboratory investigations including NLR. Results: NLR was significantly higher among HTN group with low eGFR (3.2±1), followed by HTN group with normal eGFR (1.9±0.98) with p value = 0.019, while lymphocyte was significantly lower among HTN group with low eGFR (1.7±0.3) followed by HTN group with normal eGFR (2.2±0.5) with P value 0.005. Neutrophils and NLR were significantly higher among stage IV CKD patients (6.1±2, 3.3±1.1 respectively) followed by stage III patients (5.8±1.4, 2.9±0.99 respectively) with p values were 0.031, 0.022 respectively. There was significant correlation between NLR and blood pressure, urea, creatinine, eGFR, albumin/creatinine ratio, and CRP. Conclusion: It could be concluded that NLR can be used as a marker with significant sensitivity and specificity for hypertensive nephropathy at different CKD stages.