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Renal cell carcinoma (RCC) is one of the most common malignancies of the urinary system. Its global incidence has been rising year by year in recent decades, imposing a heavy burden on public health systems. Clinically, early-stage RCC can achieve favorable prognosis through surgical resection. Nevertheless, there remains a lack of effective and comprehensive therapeutic regimens for advanced and metastatic lesions, leading to enormous challenges in clinical treatment. Conventional in vitro cell culture models fail to faithfully recapitulate the complex pathological phenotypes and disease characteristics of RCC, making them inadequate for in-depth mechanistic research. Although animal models can simulate the in vivo tumor microenvironment to a certain extent, they are restricted by interspecies differences, ethical limitations, high experimental costs and lengthy research cycles. These drawbacks hinder their seamless translation toward clinical research and greatly reduce their translational value. With the innovation of biological experimental techniques, organoid technology has achieved groundbreaking progress, opening up a brand-new avenue for precision oncology research of renal cell carcinoma. RCC organoids derived from patient tumor tissues are generated via in vitro culture systems. They can highly recapitulate the cellular biological properties, histopathological architecture and molecular expression profiles of primary tumors, and effectively improve the accuracy and reliability of preclinical drug screening. Meanwhile, the combination of organoid technology with cutting-edge approaches including single-cell sequencing, multi-omics profiling and microfluidic chips can further optimize the in vitro simulation system of the tumor microenvironment and substantially strengthen the translational efficiency and application prospects of this model. Schematic workflow of renal cancer organoid-based precision medicine pipeline. This diagram illustrates the translational application roadmap of renal cell carcinoma (RCC) organoids in precision oncology.