Starnes et al report a 14-year, single-center experience of various treatment options for renal trauma. They identified 889 patients with traumatic kidney injuries, of which 227 (25.5%) were high- grade (ie, American Association for the Surgery of Trauma grades IV and V) injuries. Overall, roughly 63.9% of all renal injuries were managed nonoperatively with most owing to blunt mechanisms. This nonoperative group includes many patients with known renal injuries who underwent a laparotomy for other reasons but had no exploration of the renal injury. For the most part, nonoperative management of renal injuries was successful; however, owing to the retrospective nature of the data, it is not known how many patients who were initially managed nonoperatively required a subsequent operation or the complication rate of those patients whose conditions failed to improve with nonoperative management. If these data were available, the clinical usefulness of this data set would be greatly enhanced. Nevertheless, this article provides invaluable data about the likely success of nonoperative management of renal trauma and the natural history of attempted renal salvage surgery.