Investigations into the relation between wine consumption and kidney disease have been limited. Patients with chronic renal failure show accelerated atherosclerotic damage and, considering the well-known protective effect of wine on the cardiovascular system, moderate wine consumption might be advantageous. Oxidative stress and endothelial dysfunction, which are inter-related, play a role in the pathophysiology of many renal diseases, including acute and chronic renal failure. Ethanol and non-alcoholic wine components, especially polyphenols, influence oxidative balance and endothelial function. Although long-term alcohol abuse has been associated with many renal alterations in humans, in experimental studies wine polyphenols enhanced kidney antioxidant defenses, exerted protective effects against renal ischemia/reperfusion injury, and inhibited apoptosis of mesangial cells. Moreover, in diabetic patients the administration of moderate amounts of red wine and a polyphenol-enriched diet slowed the progression of diabetic nephropathy. Moreover, the unfavorable effect of ethanol on blood pressure control seems to be counterbalanced by polyphenol protective effects. There is convincing evidence of a beneficial effect of controlled wine consumption patients with renal disease, but controlled clinical trials are needed to confirm this hypothesis.