Metastatic renal carcinoma concerns 30 to 50% of patients. The principal localisations are lung, liver, bone and brain. In case of unique localisation the treatment is almost surgical whatever the organ may be with sometimes long remissions. In case of many localisations, targeted therapy is the gold standard of treatment in first or second line. In France, today, 4 drugs are currently approved (sunitinib, sorafenib, temsirolimus, bevacizumab). Because of a poor prognosis trials testing combination of therapies are required to benefit patients. At least nephrectomy is necessary looking forward prospective studies to estimate its real impact.