Transfer RNA-derived small RNAs (tsRNAs) are a class of regulatory non-coding RNAs generated through enzymatic cleavage of precursor or mature tRNAs. In recent years, tsRNAs have garnered growing interest in nephrology due to their diverse biological functions and potential clinical significance. This review summarizes current research on the roles of tsRNAs in kidney diseases, including their involvement in gene expression regulation, signal transduction, apoptosis, and inflammation-related pathways. We further highlight their emerging mechanistic contributions in conditions such as acute kidney injury, chronic kidney disease, and glomerulonephritis. Finally, we discuss the prospects of tsRNAs as novel biomarkers for early diagnosis, prognosis assessment, and therapeutic targeting in renal disorders, aiming to offer new insights into kidney disease pathogenesis and management.