Background: Fetuin-A is a liver-derived plasma protein, mediates the formation and stabilization of calciprotein particles formation, ensures mineral solubilization, thus preventing pathological calcification, also it promotes insulin resistance. Objective: To study the role of fetuin A as a marker for early diabetic nephropathy in type 2 diabetes mellitus. Subjects and Methods: Cross sectional study including 30 diabetic patients without microalbuminuria (group I), 30 diabetic patients with microalbuminuria (Group II) and age and sex matched 30 healthy subjects served as a control group. All patients and control subjects were thoroughly examined clinically. Fasting and post prandial blood sugar, HbA1c, renal function tests, lipid profile, creatinine clearance, albumin/creatinine ratio and serum fetuin A by ELISA were investigated. Results: Serum Fetuin A increased in diabetic nephropathy patients without microabuminuria compared to those with microabuminuria. Significant negative correlation was found between serum Fetuin A and albumin/creatinine ratio in diabetic patients with and without microalbuminuria. Cut off value of serum fetuin A was >294.2 ug/dl with sensitivity of 93.3% ,specificity 93% , positive predictive value 92.7%, negative predictive value 93.8% and diagnostic accuracy 91.6%. Conclusion: Serum fetuin A can be used as an early marker for diabetic nephropathy before development of microalbuminuria in patients with type 2 diabetes mellitus.