Treatment used for 18 patients with major blunt renal trauma is presented. Emergency computerized tomography scan was performed in all cases. There were 10 cases of Grade III and 8 cases of Grade IV injury. All of the cases were treated by conservative management which included bed rest, blood pressure and hemoglobin monitoring, high fluid intake, antibiotics and analgesics .The mean hospital stay was 15.6 days. Seven of 18 patients required transfusions (3 in Grade III, 4 in Grade IV) to a volume of 3.8 units. Two patients underwent laparotomy for associated intra-abdominal injuries (spleen rupture in one, liver laceration in another). Infected urinoma occurred in one case; double J stent was inserted for several days. There were no instances of hypertension during the hospitalization. All patients were discharged uneventfully. Follow-up renal sonogram was available in 10 patients and renal CT was available in 6 patients. All of the kidneys were functioning and only focal scarring was noted in the previously injured renal units. All the patients remained clinically asymptomatic and all the cases had normal blood pressure. In conclusion, conservative treatment resulted in an excellent outcome for all these patients. The in-hospital morbidity was minimal, and the follow-up results were good. Early surgical exploration of the blunt renal trauma should be reserved for renal pedicle injury or hemodynamic instability. Emergency CT is an invaluable tool for classifying and managing patients.