The clinical manifestations of renal cell carcinoma are many and varied. The classic triad of gross hematuria, flank pain and the presence of a mass indicates an advanced stage of disease and are the presenting signs in less than 15 percent of patients. Metastases are present in approximately one-third of patients at initial diagnosis. Tumors can be grouped into four stages, and in the vast majority of patients these can be accurately assessed with CT and ultrasound. With CT available, arteriography is no longer considered routine in renal cell carcinomas and should be restricted to certain circumstances. Ultrasound is extremely valuable in the diagnosis of renal carcinoma, and with the use of real-time scanning and more recently the Doppler mode, its potential is impressive. However, it is dependent on body habitus and relatively gas-free abdomens. With CT, a mass can be readily identified, accurately diagnosed in over 95 percent of patients, and staged with a minimum of invasive procedure. Since the advent of CT, the role of arteriography has diminished, as is the case with venography. CT is as good as arteriography and ultrasound in the diagnosis of the indeterminate renal mass, and is particularly useful in the post-nephrectomy patient.