The presence of tumour in a solitary kidney is an absolute indication for a nephron-sparing approach. Unique challenges exist in this patient population, and one must balance the desire for oncological control against predicted renal functional impairment, procedural complications and competing co-morbidities. Due to a lack of evidence, absolute indication renal tumour patients are not considered separately from all comers in current guidelines, except for stating that nephron-sparing approaches should be prioritised in this situation