Extracellular vesicles have been isolated in various body fluids including urine. The cargo of urinary extracellular vesicles (uEVs) is composed of proteins and nucleic acids reflecting the physiological and possibly the pathophysiological state of cells lining the nephron. Because urine is a non-invasive and readily available biofluid, the discovery of uEVs has opened a new field of biomarker research. Their potential use as diagnostic, prognostic, or therapeutic biomarkers for various kidney diseases, including glomerulonephritis, acute kidney injury, tubular disorders and polycystic kidney disease is currently being explored. Some challenges, however, remain. These challenges include the need to standardize isolation methods, normalization between samples, and validation of candidate biomarkers. Also, the development of a high-throughput platform to isolate and analyze uEVs, for example an enzyme-linked immunosorbent assay, is desirable. Here, the authors review recent studies on uEVs dealing with kidney physiology and pathophysiology. Furthermore, they discuss new and exciting developments regarding vesicles, including their role in cell-to-cell communication and the possibility to use vesicles as therapy for kidney disorders.