Cancers of the kidney are prevalent malignancies with a higher case rate in men, especially those over the age of 65, and are frequently associated with risk factors such as smoking, hypertension, and obesity. RCC presents substantial clinical challenges due to its genetic and molecular heterogeneity. Chimeric antigen receptor (CAR) T-cell therapy engenders modifying a patient’s T lymphocytes to display CARs that specifically target cancer cells has achieved notable success in hematologic malignancies like leukemia and lymphoma. However, its application to solid tumors, including RCC, is fraught with obstacles. These include antigen escape, the immunosuppressive tumor microenvironment (TME), and physical barriers that hinder effectiveness. In RCC, CAR-T faces significant hurdles, including difficulties in identifying specific tumor antigens and managing off-target toxicities. Past trials targeting antigens such as CAIX and VEGFR2 have encountered severe adverse effects or a lack of efficacy, leading to discontinuation. Current research endeavors are directed toward optimizing CAR-T constructs, exploring novel antigen targets, and integrating CAR-T therapy with adjunctive treatments like radiotherapy. The combination of CAR-T with radiotherapy has demonstrated potential by enhancing immune responses and improving CAR-T cell infiltration into RCC tumors. Current clinical trials are investigating CAR-T therapies aimed at targeting specific antigens like CD70 and ROR2, with preliminary results showing promise. These trials aim to refine strategies that effectively target and eradicate RCC while mitigating associated toxicities. Despite the challenges, advances in CAR-T design and combination therapies hold potential for overcoming the barriers presented by solid tumors and improving the armamentarium available for treatment.