OBJECTIVE To review the conservative management of pediatric renal trauma and investigate the significance of associated nonrenal injuries. METHODS We performed a retrospective review of 63 pediatric patients with blunt renal injury who were treated expectantly. A comparison was made between operative and nonoperative management, mechanism of injury, treatment complications, requirement for blood transfusion, length of hospital stay, associated injuries, and incidence of pre-existing urologic conditions. RESULTS The renal injury grade was grade I in 31 patients, grade II in 12, grade III in 8, grade IV in 10, and grade V in 2. Two patients underwent acute surgical exploration; one for nonrenal causes and one (2%) for life-threatening renal bleeding (grade V injury). Renorrhaphy was not performed, and 98% of patients were initially treated nonoperatively. Three patients (5%) underwent delayed renal surgery: one nephrectomy for Wilms' tumor, one partial nephrectomy for nonhealing grade IV injury, and one attempted repair of a renal pelvis injury with subsequent nephrectomy. Excluding 1 patient who died and one nephrectomy for tumor control, our renal salvage rate was 97% (59 of 61). The overall mean hospital stay was 7.7 days and was similar across all grades (grade I, 7.7 days; grade II, 7.8; grade III, 6.1; grade IV, 9.2; and grade V, 10.5 days). CONCLUSIONS The results of our study have shown that pediatric patients with blunt nonexsanguinating renal injuries treated conservatively do well. The length of hospital stay did not increase with worsening severity of renal injury and, instead, was determined by the severity of the nonrenal associated injuries. This report adds to a growing body of published data that suggest that conservative management of pediatric blunt renal trauma is safe.