Lin X, et al. - Given different histopathological characteristics are shown by nonfunctioning kidneys secondary to various etiologies, and there exist very limited investigations centered on incidence and types of renal neoplasms applying the new World Health Organization and International Society of Urological Pathology classification system in several types of nonfunctioning kidneys, so, researchers addressed this topic in this study. They found 311 nephrectomies of nonfunctioning kidneys and grouped them into 5 classes: acquired cystic kidney disease (ACKD, n = 61); end-stage renal disease, nonspecific (ESRD, n = 63); adult polycystic kidney disease (APKD, n = 49); failed transplant kidney (FTK, n = 96); and those resulted from obstructive conditions in the kidney (OCK, n = 42). Higher cancer incidences were reported for ACKD (70%) and ESRD (43%) vs the other 3 groups. Besides clear cell renal cell carcinoma (RCC) and papillary RCC, a much higher incidence of clear cell papillary RCC was evident in ACKD patients vs other groups. Significantly longer dialysis duration was observed in ACKD patients vs ESRD, APKD, and FTK. Findings although revealed early pT1 stage for most RCCs developing in these nonfunctioning kidneys, the presence of higher-stage diseases was reported in 6 ACKD patients and 3 ESRD patients, and higher-stage diseases can be fatal if not managed properly. Thus, for the prediction of kidney cancer risk, it is crucial to ensure the accurate clinicopathological classification of these nonfunctioning kidneys. These revelations call for active monitoring of the patients having high-risk nonfunctioning kidney diseases as well as proper surgical management when required.