Farzaneh Futuhi
1 
, Zahra Sahraei
2 , Nayyereh Akbari
3* 1 Department of Adult Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Neurology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Brain metastasis (BM) from renal cell carcinoma (RCC) represent a significant clinical challenge, associated with high morbidity and poor prognosis. The advent of targeted therapies and immune checkpoint inhibitors (ICIs) has transformed the management of metastatic RCC (mRCC), yet patients with brain metastasis remain underrepresented in clinical trials, and optimal management strategies are still evolving. The findings indicated that brain metastasis occur in approximately 5–15% of patients with mRCC, with clear cell histology and the presence of extracranial metastases as key risk factors. The pathophysiology involves complex molecular mechanisms, including hematogenous dissemination and genetic alterations. Clinical presentation is often symptomatic, with headaches, focal deficits, and seizures, but a substantial proportion of cases are detected incidentally. Magnetic resonance imaging (MRI) remains the gold standard for diagnosis, though screening is typically reserved for symptomatic or high-risk patients. Treatment is multimodal: surgery and stereotactic radiosurgery (SRS) are mainstays for local control, while systemic therapies, particularly cabozantinib and ICI-based regimens, have shown promising intracranial activity. Prognosis remains guarded, with median survival after BM diagnosis ranging from 10 to 18 months, but outcomes have improved in the ICI era. In conclusion, the management of RCC brain metastases requires a multidisciplinary, individualized approach. Advances in systemic and local therapies have improved survival, but significant challenges remain, including the risk of intracranial hemorrhage and the need for better screening and surveillance strategies. Ongoing research into molecular mechanisms and novel therapeutics holds promise for further progress in this high-risk population.
Implication for health policy/practice/research/medical education:
Brain metastasis (BM) from renal cell carcinoma (RCC) remain a challenging complication marked by high morbidity and historically limited survival, though outcomes have improved with advances in surgery, radiotherapy, and modern systemic therapies such as cabozantinib and immune checkpoint inhibitors (ICIs). Optimal care relies on early detection, timely local treatment for symptomatic or limited disease, and thoughtful integration of effective systemic agents. Important gaps persist, including the need for improved surveillance, better management of complications like intracranial hemorrhage, and greater inclusion of these patients in clinical trials.
Please cite this paper as: Futuhi F, Sahraei Z, Akbari N. Kidney cancer metastasis to the brain; a narrative review study. J Nephropathol. 2026;x(x):e28706. DOI: 10.34172/jnp.2026.28706.