The vasculature wall is an active, integrated organ composed of endothelial cells and vascular smooth muscle cells, as well as other cell types depending on the specific vascular segment (e.g. fibroblasts in many vascular regions). The vascular wall is not static; the vascular components (cells and extracellular matrix) dynamically increase, decrease or reorganize, or both, in response to physiological and pathological stimuli. The vascular smooth muscle cells are the final common pathway for many of these dynamic changes in vascular wall structure. In the renal glomerulus, however, the glomerular mesangial cells-a cell phenotypically related to the vascular smooth muscle cells-also participate. Although sometimes beneficial, changes in vascular or glomerular structure often lead to cardiovascular (e.g. atherosclerosis, restenosis, intimal hyperplasia) and renovascular (e.g. glomerulosclerosis) diseases. Consequently, much effort has been expended to elucidate the mechanisms that control growth and extracellular matrix production by vascular smooth muscle cells and glomerular mesangial cells. The purpose of this review is to discuss recent developments.