The risk for developing metastases or recurrence depends on the initial tumor stage. Most metastases of renal cell carcinoma occur within the first 3 years after nephrectomy or kidney-sparing surgery. Imaging is focused on the lungs and abdomen, which are the most common locations of metastases. Exposure to radiation caused by follow-up should be taken into account. The follow-up protocol has to be tailored to the stage constellation of each patient to avoid unnecessary examinations and costs.