The renal vascular system is vital for maintaining the normal function of kidney, and vascular endothelial growth factor-A (VEGF-A) participates in the development of renal vascular system and is associated with various kidney diseases.Studies have demonstrated that down-expression of renal VEGF-A can result in reduction of microvascular density in medulla kidney, regional hypoxia, and polycythemia, and further lead to increased haemopoietin. The overexpression of VEGF-A can cause renal fibrosis and cyst formation, promoting the progress of kidney disease. Therefore, regulation of VEGF-A expression may influence the occurrence and development of kidney diseases. This review summarized the role of VEGF-A in the renal vascular system and kidney diseases, hoping to provide new therapeutic strategies for kidney diseases.