OBJECTIVES: São Paulo is a Brazilian state with the largest number of cancer reference hospitals and hosts 21% of country population. This study aims to describe hospitalization patterns and costs for renal cell carcinoma (RCC) in public hospitals in São Paulo state, Brazil. METHODS: A retrospective analysis of São Paulo public hospital admissions for RCC was developed according to ICD-10 classification (C64) as reported in Brazilian Hospital Information System (SIH/DATASUS) database from January 2007 to December 2011. Admissions were categorized into surgical (containing any surgical procedures codes at hospitalization data eg.: tumor excision, biopsy, etc.) or clinical (all non-surgical eg.: chemotherapy, infection treatment, anemia, etc.). Costs represent federal reimbursement values for hospitalizations (includes medical procedures, exams, medications and taxes), presented in 2012 Brazilian Real (BRL). Average 2012 exchange rate was 1,9544BRL/USD. RESULTS: In the period, 4,138 hospital admissions were identified (951, 1,126, 1,207, and 854 for 2007, 2008, 2009, and 2011, respectively), and total cost was 5,472,534BRL, which represents 0.78% of all cancer in-hospital treatment in the state. Mean cost per patient was 1,326BRL, 675BRL, and 1,854BRL for all hospitalizations, clinical and surgical procedures, respectively. Surgical procedures were responsible for 55.07% of cases, and 77.29% of total costs, with partial or total nephrectomy representing the main cause (48.9%). Mean length of stay was 6.99 days. In-hospital mortality rate was 9.98% for all cause (17.7% and 3.69% for clinical and surgical procedures, respectively). When compared to the national cases, São Paulo represents 29.74% of them, while representing 33.18% of total national hospitalization costs related to RCC. CONCLUSIONS: RCC hospitalizations costs in São Paulo are responsible for less than 1% of all cancer in-hospital treatments in the state, which may suggest under-diagnosing when compared to international incidence rates. São Paulo is an important RCC treatment center in Brazil, capturing about one third of country resources.