Objective To explore the value of high-frequency ultrasound combined with Firefly imaging technology in assessing early renal injury in patients with asymptomatic hyperuricemia (AHU) and to construct an individualized risk prediction nomogram model. Methods A total of 127 AHU patients admitted to the hospital from January 2020 to December 2020 were selected as the study subjects. They were divided into an injury group (n=29) and a non-injury group (n=98) based on the occurrence of early renal injury. General data, laboratory indicators, high-frequency ultrasound, and Firefly imaging parameters were collected. Univariate and multivariate logistic regression analyses were used to screen for independent risk factors, and a nomogram prediction model was established. Internal validation was performed using the Bootstrap method. The model''s discrimination and calibration were evaluated via the ROC curve and calibration curve. Results Univariate analysis showed that the duration of hyperuricemia, comorbid hypertension, daily water intake, levels of serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), serum uric acid (SUA), serum cystatin C (Cys-C), urinary albumin-to-creatinine ratio (UACR), urinary α1-microglobulin (U-α1-MG), urinary N-acetyl-β-D-glucosaminidase (U-NAG), renal cortical thickness, enhanced renal cortical echogenicity, blurred corticomedullary differentiation, number of microcalcifications on Firefly imaging, interlobar renal artery resistance index, and renal sinus fat thickness were factors associated with early renal injury in AHU patients (all P < 0.05). Logistic regression analysis identified high SUA level, long duration of hyperuricemia, Firefly imaging microcalcifications ≥3, high interlobar renal artery resistance index, and enhanced renal cortical echogenicity as risk factors for early renal injury in AHU patients (all P < 0.05). The nomogram model constructed based on these factors had an AUC of 0.856 for predicting early renal injury in AHU patients. The calibration curve and the Hosmer-Lemeshow test (P > 0.05) confirmed excellent calibration of the model. DCA showed that the model had a clear clinical net benefit within a threshold probability range of 15% to 70%. Conclusion High-frequency ultrasound combined with Firefly imaging technology can sensitively detect early microstructural and microcirculatory abnormalities in the kidneys of AHU patients.