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Fine needle aspiration cytology (FNAC) is used for preoperative diagnosis of paediatric renal tumours, especially in centres where preoperative chemotherapy is advocated in Wilms ’ tumour. This review focuses on salient cytological features in specific paediatric renal tumours, the approach to resolving a differential diagnosis and the role of ancillary methods in diagnosis of paediatric renal tumours. Crucial differential diagnoses include distinguishing: Wilms ’ tumour from benign tumours in the kidney like multicystic nephroma or congenital meso-blastic nephroma; aggressive non-Wilms ’ tumours of kidney like rhabdoid tumour of kidney; and Wilms ’ tumour from other paediatric round cell sarcomas like neuro-blastoma, non-Hodgkin lymphoma etc. An approac