| INTRODUC TI ONRenal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and is the 12th most prevalent malignancy worldwide, with 338 000 newly diagnosed patients in 2012 and approximately 100 000 deaths annually. 1 Clear cell RCC (ccRCC) is pathologically the most common type and accounts for approximately 75% of all cases. 2 Although the prognosis is favorable with surgical resection for nonmetastatic RCC, approximately 20%-30% of RCC patients have metastatic sites at the diagnosis and the 5-year survival rate is less than 20%. 2,3 In addition, more than 20% of patients develop metastases during postoperative follow-up periods. 4 These clinical issues are caused by a lack of useful biomarkers for early detection of RCC and the inefficiency of therapy for patients with metastatic or treatment-resistant RCC. Abstract Analysis of microRNA (miRNA) regulatory networks is useful for exploring novel biomarkers and therapeutic targets in cancer cells. The Cancer Genome Atlas dataset shows that low expression of both strands of pre-miR-101 (miR-101-5p and miR-101-3p) significantly predicted poor prognosis in clear cell renal cell carcinoma (ccRCC). The functional significance of miR-101-5p in cancer cells is poorly understood. Here, we focused on miR-101-5p to investigate the antitumor function and its regulatory networks in ccRCC cells. Ectopic expression of mature miRNAs or siRNAs was investigated in cancer cell lines to characterize cell function, ie, proliferation, apoptosis, migration, and invasion. Genome-wide gene expression and in silico database analyses were undertaken to predict miRNA regulatory networks. Expression of miR-101-5p caused cell cycle arrest and apoptosis in ccRCC cells. Downstream neighbor of son (DONSON) was directly regulated by miR-101-5p, and its aberrant expression was significantly associated with shorter survival in propensity score-matched analysis (P = .0001). Knockdown of DONSON attenuated ccRCC cell aggressiveness. Several replisome genes controlled by DONSON and their expression were closely associated with ccRCC pathogenesis.The antitumor miR-101-5p/DONSON axis and its modulated replisome genes might be a novel diagnostic and therapeutic target for ccRCC.