The kidney is the mainly apparatus in the human body, with a complex organizational structure and diverse pathological changes closely related to other organs. Extracellular vesicles are vesicles with diameters ranging from tens of nanometers to several micrometers, originating from multiple intracellular vesicles or local cell membranes. They carry various information from the source cells and operate between various cells in the kidney and extrarenal organs, conveying substances between cells. They play a large part in signal transmission within the kidney and between the kidney and other organs. Detecting changes in extracellular vesicles and their cargo can monitor both renal neoplastic and nonneoplastic diseases. Extracellular vesicles derived from various stem cells, loaded with bioactive substances, can be applied to some extent to treat kidney diseases. Bioengineering drugs using extracellular vesicles as carriers are also playing an increasingly big role in treating kidney diseases. Research on extracellular vesicles has achieved certain results and has some preclinical applications, but there is still a process for large-scale and widespread application.