Histological and prognostic patterns of renal cell carcinoma vary greatly, sometimes hindering accurate prognosis. Classical histological prognostic factors have emerged during the last 25 years, the two predominant factors being TNM stage and nuclear Fuhrman grade. However, the use of new treatment strategies, targeting tumoral angiogenesis, make it necessary to develop new prognostic markers. Microvascular density, plasmatic and tissue expression of VEGF, such as intratumoral expression of VHL, HIF and CA IX can be useful to further evaluate prognosis and outcome. Future study as predictive factors of response or non-response to antiangiogenic therapies is of major interest for clinicians.