The management of blunt renal trauma has evolved due to advances in clinical and radiographic staging. Careful clinical evaluation and the selective use of intravenous urography (IVU) and computed tomography (CT) have allowed many patients with major renal injuries to undergo surveillance, rather than renal exploration, with low morbidity. This article reviews the current diagnosis, staging, and management of adult and pediatric blunt renal trauma and describes the technique for renal exploration and repair.