<p>Kidney diseases are prevalent worldwide and represent a significant cause of mortality, posing a substantial threat to public health. Exosomes are a type of nanoscale lipid-encapsulated structure with a diameter of 30–200&#xa0;nm. They contain a variety of substances including proteins, mRNA, and microRNA. It has been demonstrated that they fulfill a significant function in the regulation of intercellular communication. The inherent characteristics of exosomes, including their ability to regulate complex intracellular pathways, suggest a significant therapeutic potential in the treatment of numerous diseases, including renal diseases. The present review aims to provide a comprehensive overview of the application of exosome in kidney diseases, exploring the underlying mechanisms that underpin their function. Furthermore, it examines the limitations of current applications and potential solutions to address these challenges. It is hoped that this review will contribute to the advancement of exosome research and application in the field of kidney diseases.</p>