Recent studies suggest that vascular endothelial growth factor (VEGF) plays a crucial role in the preservation of renal function and may also serve as a useful biomarker in monitoring the progression of lupus nephritis (LN). Here we sought to correlate intrarenal VEGF expression with renal histopathology and prognosis of LN. Biopsy specimens from 35 patients with Class III or IV LN (ISN/RPS categorization) were found to have lower levels of intrarenal VEGF than those found in biopsy tissue taken from 10 donor kidneys sampled at the time of allograft reperfusion. This reduced amount of VEGF mRNA in the patients with LN negatively correlated with glomerular endocapillary proliferation, crescent formation, and a high histologic activity index but was positively associated with increased numbers of urinary podocytes. The level of intrarenal VEGF mRNA accurately predicted the deterioration of renal function in these patients within 12 months. Our study shows that expression of VEGF in renal tissue may serve as a molecular marker of renal damage and may be a predictive factor for short-term loss of kidney function in patients with LN.