Exosomes are membranous vesicles 30-100 nm in diameter that are actively secreted by cells to the outside of the cell. They can be extracted and isolated from urine and other biological fluids （e.g.，plasma，amniotic fluid，saliva，ascites，etc.） and carry proteins，nucleic acids，lipids，etc. that can transmit genetic material between cells and participate in cellular immune regulation. In the physiological state，urinary exosomes are mainly derived from various cells facing the lumen，and the proteins and RNAs contained in them are involved in the exchange of information between cells in the microenvironment of chronic diseases. Recent studies have shown that the extraction and isolation of urinary exosomes can be used as a diagnostic criterion for certain chronic diseases and even to determine prognosis. This article summarizes the progress of research on the therapeutic applications and mechanisms of action of urinary exosomes in metabolic diseases and cardiovascular diseases.