Abstract Autopsy-based renal histopathology provides a unique opportunity to determine the true burden and spectrum of clinically silent kidney diseases, particularly in resource-limited settings where advanced diagnostic facilities may be scarce. This study aimed to evaluate the histopathological patterns of renal lesions in autopsy specimens from a tertiary care centre in Rajasthan, India. A descriptive cross-sectional study was conducted on 180 consecutive autopsy kidney specimens received in the Department of Pathology over one year. Properly fixed specimens were examined grossly and microscopically using haematoxylin and eosin staining, with special stains when required. Lesions were categorised as glomerular, non-glomerular, or normal. Demographic variables were correlated with histopathological findings using descriptive statistics and significance testing (p < 0.05). Of the 180 specimens, 25% were microscopically normal, while 75% showed pathological changes. Non-glomerular lesions predominated (52.8%), followed by glomerular lesions (22.2%). Acute tubular necrosis (31.6%) and chronic pyelonephritis (26.3%) were the most frequent non-glomerular findings. Among glomerular lesions, focal segmental glomerulosclerosis was most common (30%), followed by diffuse glomerulosclerosis (20%) and membranous glomerulonephritis (15%). The majority of cases occurred in the 50–70-year age group, with male predominance (65.6%). No statistically significant association was observed between age or sex and lesion type. A substantial proportion of autopsy kidneys harbour occult pathological changes, emphasising the importance of routine histopathological examination for accurate disease burden estimation, clinicopathological correlation, and public health planning.