This review provides an overview of the current understanding and clinical status of mesenchymal stromal cells (MSCs). MSCs are a rare subset of pluripotent stromal cells found in various adult tissues, known for their potential to differentiate into diverse cell lineages. They exhibit beneficial effects in tissue repair and regeneration, modulating the inflammatory response and showing immunosuppressive properties. Preclinical studies have demonstrated the use of allogeneic MSCs, leading to their application in clinical settings. The review highlights the cardiovascular and renal applications of MSCs, including their ability to home to injured tissues, modulate immune responses, and improve tissue function. However, challenges such as the lack of conformity in isolation and culture expansion protocols, and the heterogeneity of MSC populations, remain obstacles. Despite these issues, clinical trials have shown encouraging results, with some studies reporting improved cardiac function and reduced graft-versus-host disease. The review also discusses the future directions for MSC-based therapy, emphasizing the need for long-term studies to validate the nature of MSC-based treatments.This review provides an overview of the current understanding and clinical status of mesenchymal stromal cells (MSCs). MSCs are a rare subset of pluripotent stromal cells found in various adult tissues, known for their potential to differentiate into diverse cell lineages. They exhibit beneficial effects in tissue repair and regeneration, modulating the inflammatory response and showing immunosuppressive properties. Preclinical studies have demonstrated the use of allogeneic MSCs, leading to their application in clinical settings. The review highlights the cardiovascular and renal applications of MSCs, including their ability to home to injured tissues, modulate immune responses, and improve tissue function. However, challenges such as the lack of conformity in isolation and culture expansion protocols, and the heterogeneity of MSC populations, remain obstacles. Despite these issues, clinical trials have shown encouraging results, with some studies reporting improved cardiac function and reduced graft-versus-host disease. The review also discusses the future directions for MSC-based therapy, emphasizing the need for long-term studies to validate the nature of MSC-based treatments.