Renal cell carcinoma is a relatively uncommon tumour with a widely varying prognosis depending on several tumour and clinical factors. This review discusses these factors and critically appraises their value both as individual markers and when they are incorporated into scoring systems/models or algorithms. Disease stage (assessed pathologically and/or clinically) and performance status have the strongest evidence as helpful individual prognostic markers but a better discrimination is obtained by combining these and adding in various other indices. Prospective validation of such integrated prognostic models will be essential.