Renal artery injury is an uncommon consequence of blunt abdominal trauma and probably is often missed. We recently saw three patients with rupture of the left hemidiaphragm associated with renal artery injury. The finding of a perinephric hematoma in a multiply injured patient with an ipsilateral diaphragmatic rupture prompted evaluation of the renal artery. With massive injury, the kidney may be displaced superiorly when the diaphragm ruptures, producing injury to the ipsilateral renal artery. This association has not been emphasized in the literature. The finding of a perinephric hematoma on the left should prompt full evaluation of the renal arteries if seen in association with diaphragmatic rupture.