Apheresis has been used frequently to treat a variety of renal disease. The efficacy of apheresis has been assessed extensively in primary and secondary forms of rapidly progressive glomerulonephritis (RPGN), including immune complex-mediated glomerulonephritis and pauciimmune RPGN. Other disorders to which the procedure is often applied include refractory nephrotic syndrome due to focal glomerulosclerosis, lupus nephritis, acute renal failure associated with myeloma, and allograft rejection. There are various kinds of evidence that apheresis is a useful adjunct to conventional immunosuppression in the treatment of these diseases. In this review, we describe the effect of apheresis as initial monotherapy in several kinds of renal disorders, and discuss the putative criteria for the appropriate indications of therapeutic apheresis in the treatment of renal diseases.