Inclusion Criteria:

- age ≥ 18 years

- ECOG Performance Status 0 - 1

- Biopsy (primary tumour or metastases) confirming the diagnosis of clear cell
carcinoma

- Documented metastatic disease

- Absence of prior systemic treatment for kidney cancer including AA

- Tumour amenable to nephrectomy (partial or total) in the opinion of the patient's
urologist. Patients presenting with an inferior vena cava thrombosis can be included.

- Patients for which the indication of Sunitinib is considered according to the
recommendations rules given by national health authorities of participating
countries. The prescription of Sunitinib in the circumstances of the study is
considered as a standard treatment.

- Platelets > or = 100 x 109/L, haemoglobin >or = 9 g/dl, neutrophils >or = 1.5 x
109/L;

- Bilirubin < or = 2 mg/dL, aspartate transaminase (ASAT) and alanine transaminase
(ALAT)< or = 2.5 times the upper normal limit (UNL) or < or = 5 times UNL for
patients with liver metastases

- Patients of child bearing age should use contraceptive methods

- Patient able to follow the procedures outlined in the protocol as far as the planning
of visits and examinations are concerned.

- Life expectancy ≥ 3 months

- Written informed consent

Exclusion Criteria:

- Prior systemic treatment for kidney cancer (including Anti Angiogenic)

- Bilateral kidney cancer

- Pregnant or breast feeding women

- Acute coronary syndrome or episode of myocardial infarction or severe or unstable
angina within the last 6 months as well as severe diabetes with severe peripheral
arteriopathy or deep phlebitis not treated with low molecular weight heparin or
arterial thrombosis within the last 3 months

- Patients being treated with antivitamin K (please note that patients being treated
with low molecular weight heparin can be included)

- Medical, general or psychiatric difficulties which, in the opinion of the
Investigator, would make it inappropriate for trial entry

- Symptomatic or untreated brain metastases (patients with brain metastases that have
been treated by radiotherapy or surgery and have stable disease within 6 weeks, and
are not requiring treatment with corticosteroids can be included)

- Previous history of gastric disease or malabsorption, syndrome compromising the
absorption of Sunitinib

- Experimental treatment within the 28 days preceding inclusion

- Other cancer within the previous 5 years (except for insitu skin carcinoma and
treated localised prostate cancer with undetectable PSA)

- Patient has received treatment with IV biphosphonate