ABSTRACT:In the setting of blunt renal trauma and selected instances of penetrating renal trauma, a non-operative approach may be selected. Deep cortical lacerations with or without urinary extravasations followed by trauma have traditionally been managed by exploration and surgical repair. Patient selection is the preliminary step in adopting a non-operative management strategy to renal trauma. One series, with predominantly blunt mechanisms of injury, documented that 85% of patients were treated successfully without surgery. Ultimately, the exclusion of concurrent injury may be the key point in treating patients non operatively. With improved and easily available radiological imaging facilities like intravenous pyelography, ultrasonography, computed tomography and angiography, we propose that the majority of these injuries can be followed expectantly with delayed intervention if needed. 46 patients of abdominal trauma with significant renal injuries were reviewed. 16 patients had Grade I, 12 patients had grade II, 8 patients had Grade III, 6 had Grade IV renal injuries and 4 patients had Grade v. 37(80.4%) patients responded to conservative management. 9 patients required operative intervention. 25 patients had associated injuries. There was loss of 1 renal unit in 2 cases. With the aid of computed tomography, conservative therapy for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss.