Abstract Background and Aims A reliable assessment of renal function in onco-nephrology and especially in oncological solitary kidney (SK) is of paramount importance. Nowadays, the use of estimated GFR is predominant in clinical practice because it is fast, easy and cost-effective. However, eGFR harbours a significant error in comparison to gold standards methods using exogenous molecules such as iohexol or iothalamate (mGFR). Aim of this study was to determine the extent of the error of eGFR compared to the mGFR in onco-nephrological patients with a solitary kidney (SK) after nephrectomy (RN). Method A total consecutive cohort of 200 SK who previous underwent RN for renal cancer was enrolled in a single tertiary institution from 2017 to 2023 to compare the most used eGFR formulas (MDRD, CKD-EPI crea 2012, CKD-EPI 2021 crea, CKD-EPI cyst 2012, CKD-EPI Cyst 2021, CKD-EPI cyst/creat, Cockroft-Gault) with a mGFR method using Iohexol Plasma Clearance. Clinical and laboratory data were reported for each patient. True positives (TP) and False positives, (FP) were classified in CKD stages based on eGFR and mGFR. Comparisons between groups were performed using Wilcoxon ranks sum test for numerical variables and Pearson's Chi square test for categorical ones. Results Overall median age was 67 years (IQR: 56.75), median BMI 24.8 (IQR: 22.8; 27.7), Male: 74.9%,F: 25.1% Diabetes: 10.9% Hypertension: 53.8%, CKD stage I: 3.7%, II: 25.5%, IIIA:28,IIIB: 27.5%, IV: 13.4%, V: 1.74%, mean Creatinine:1,46 mg/dl (1.16-1,84), cystatin: 1.23 (0.95-1.56). Surprisingly, SK cohort harboured a non-negligible errors in each CKD class with a huge discrepancy between the eGFR formulas and the gold standard method (Figs 1 and 2), suggesting the great relevance of mGFR in the clinical decision making algorithm. Conclusion The use of mGFR in nephrectomized patients for RC remains fundamental to avoid misleading evaluations and to perform correct personalized pharmacological therapies.