Background <p>Kidney diseases, including both acute and chronic conditions, present significant global health challenges. Macrophages and endothelial cells play critical roles in the onset and progression of these diseases. This review aims to explore the bidirectional interactions between macrophages and endothelial cells and their roles in kidney diseases.</p> Method <p>By analyzing existing literature, this paper focuses on discussing the interaction mechanisms between macrophages and endothelial cells in acute kidney injury (AKI) and chronic kidney disease (CKD), including cytokine secretion, exosome transport, and adhesion molecule expression.</p> Result <p>Research demonstrates that macrophages regulate endothelial function and angiogenesis through cytokine release, exosome transfer, and adhesion molecules, while endothelial cells control macrophage recruitment and activation via adhesion molecules. These interactions are essential in balancing kidney injury and repair, as well as modulating inflammation and fibrosis.</p> Conclusion <p>The current research is mostly based on the animal models and has not fully addressed the issue of species-specific differences. Future research should combine multi-omics technology and patient-derived organoids to validate therapeutic targets and promote clinical translational research.</p>