BACKGROUND Nephrectomy is the standard surgical treatment of neoplastic and non-neoplastic lesions in the kidney and provides more insight into the detailed histopathology of renal lesions. We wanted to identify the age groups, gender distribution and different histopathological types and subtypes of non-neoplastic and neoplastic lesions in nephrectomy specimens over a period of ten years. METHODS A retrospective analysis was done over a period of ten years (January 2006 to December 2015). All nephrectomy specimens received in the Department of Pathology, Government Medical College, Kottayam were recorded from histopathology registers and analysed with regard to age, gender and histopathological types. RESULTS A total of 532 lesions was encountered in our analysis. Males (61.8 %) were affected more than females (38.2 %). Lesions were more on the left side (50.8 %) than right side (49.2 %). Non-neoplastic lesions (53 %) outnumbered neoplastic lesions (47 %). Inflammatory and obstructive causes constituted the majority (43.8 %) in non-neoplastic lesions and renal cell carcinoma was the commonest neoplasm (71.2 %). CONCLUSIONS There is a wide age distribution of renal diseases in the present study. Inflammatory and obstructive conditions constituted the most common indication for nephrectomy, followed by malignant tumours. KEYWORDS Renal Cell Carcinoma, Nephrectomy, Pyelonephritis, Simple Renal Cyst, Wilms Tumour