For certain major rivers and wetlands, hydrological information can often be difficult to obtain due to the inaccessibility of the region, the sparse distribution of gauge stations, or the slow dissemination of data. Satellite radar altimeters have the potential to monitor height variations over inland waters. Here, it is shown that the NASA radar altimeter (NRA), currently operating on board the TOPEX/POSEIDON satellite, can successfully track both large wetlands and rivers of >1 km width. The coverage, performance, and limitations of the NRA altimeter are discussed with relevance to these regions, and the merits of utilizing the geophysical data records (GDRs) and the sensor data records (SDRs) are explored. Time series of relative water level variations, for the first ∼3.7 years of the mission, have been obtained for a selection of the world's largest rivers, and for major wetlands of international importance. Validation shows the results can be accurate to ∼11 cm rms, offering the potential to observe these regions as part of a long-term hydrological monitoring program.