Successful management of patients with renal trauma requires definition of the extent of injury and knowledge of the indications for exploration. The 185 consecutive cases of renal trauma requiring surgery at Parkland Memorial Hospital between 1976 and 1980 are reviewed. Injury was due to penetrating trauma in 85% of cases, and blunt trauma in 15%. The most common associated injuries following penetrating trauma were to liver, small bowel, stomach, and colon; splenic injury was more common in blunt trauma. Renal pedicle injuries in 26 patients (14%) had an operative mortality of 12% compared to 5.4% for the entire group. Renal salvage occurred in 85, 70, and 64% of stab wounds, gunshots, and blunt trauma, respectively. The importance of prompt and accurate radiographic assessment of injury with aggressive use of renal arteriography is stressed.