Salem MS, et al. - The current optimal management of traumatic renal injuries (TRIs) is investigated, with a focus on high-grade and penetrating injuries. Searching the Pietermaritzburg Metropolitan Trauma Service registry, researchers identified 13,315 injured patients treated by the PMTS between 1 January 2012 and 31 December 2016; of these, 223 (1.7%) had TRIs. In the management of TRI, a progression towards non-operative management and surgical minimalism has been observed. Nonoperative management is possible in most of the patients with TRI, with a low failure rate, even in high-grade injuries and penetrating trauma. Nephrectomy can be avoided in the assistance of endourological or endovascular techniques. Penetrating mechanism, high-grade injury (AAST III-V) and metabolic acidosis on presentation were the risk factors for nephrectomy. Associated injuries more frequently led to mortality than TRI.