© 2014 The Authors BJU International © 2014 BJU International. Objective: • To review the literature and make practical recommendations regarding the conservative management of renal trauma. Patients and Methods: • Relevant articles and guidelines published between 1980 and 2014 were reviewed. • Graded recommendations were constructed by a multi-disciplinary panel consisting of urologists, radiologists, and infectious disease physicians. • These recommendations underwent formal review and debate at the Western Australian USANZ 2013 state conference, and were presented at the USANZ 2014 annual scientific meeting. Results: • The literature on the conservative management of renal trauma is reviewed within the framework of the American Association for the Surgery of Trauma (AAST) kidney injury severity scale. • Graded recommendations are made regarding several key topics including: imaging, inpatient management, antibiotics, return to activity, and follow-up. • Grade IV injuries and intraoperative consults are examined separately in view of the difficulties these groups cause in making appropriate treatment decisions. Conclusion: • A practical clinical guideline is provided regarding the conservative management of renal trauma.