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Kidneys are the most injured genitourinary organ in external trauma, and it is estimated that 1–5% of all traumas and 10% of abdominal traumas sustain a renal injury [1–4]. In a series consisting purely of blunt abdominal trauma mechanism, 15% of patients were found to have an injury to the kidneys [5]. Of all patients who sustain genitourinary trauma, over half of them involve the kidney [6]. A population‐based study found the incidence of renal trauma to be 4.9 per 100 000 population ≥16 years of age in the United States [4]. The majority of these patients were young and male, with 72% between the ages of 16 and 44 and 75% male. In an analysis of pediatric genitourinary injuries, renal injuries were found to make up 3.5% of the cohort, but the incidence has not been defined [7].

There is variation in the etiology of renal trauma based on geographical location; series from Low and Middle‐Income Countries (LMIC) suggest that the rates of penetrating trauma are high, with the majority of blunt trauma caused by road traffic accidents, assault, and falls [8–11]. In the More Economically Developed Countries (MEDC), the vast majority (90–95%) of renal injury is sustained by blunt trauma, which is caused by motor vehicle collisions (63%), falls (14%), sports injuries (11%), pedestrian accidents (4%), motorcycle crashes (2%), assault (2%), and the remaining from other causes [6, 12, 13]. In a recent blunt renal trauma series, 80% of injuries were found to be grade I–II renal injuries, 9.5% grade III, 8.1% grade IV, and 2.7% grade IV [5]. Thus, imaging all renal injuries is unnecessary, and criteria have been developed (see below). Table 1.1 summarizes the large (n > 100) series with emphasis on blunt injuries.

Table 1.1 Demographics of renal trauma.

SERIES a	[6]	[14]	[15]	[1] b	[4]	[16]	[5] b	[17]	[18]	[19]
Year published	1984	1986	1995	2001	2003	2012	2012	2013	2013	2014
Renal injury (N)	154	132	2254	227	6231	1505	221	338	9002	105
Renal injury (%)	2.9	3.25	n/a	1.4	1.2	n/a	n/a	n/a	n/a	n/a
Blunt (%)	93.5	95.4	89.8	93.4	81.6	95.0	100	96.2	82.0	96.1
Penetrating (%)	6.5	4.6	10.2	6.6	18.4	5.0	0	3.9	17.8	3.9
Grade IV–V (%)	n/a			14.6			10.9	29.3	21.1	23.5
Initial non‐operative management among all trauma (%)		92.6	92.6	n/a	88.6	94.5	n/a	92.6	86.8	98.0
Initial non‐operative management among blunt trauma (%)			98.3	89.5/92.9?	96.3		92.3	92.6	94.4
Nephrectomy (%) among all trauma	3.8	3.2			7.9	3.1	n/a	7.1	8.6	1.9
Nephrectomy (%) among blunt trauma			0	7.2	3.3		5.4	7.4	4.7

Blank cells indicate missing data.

^a Series with N < 100 not included.

^b Data showing grade and management of blunt renal injuries only.