Selected penetrating renal injuries avoid exploration

Selected patients with grade III–IV penetrating renal injuries retained their kidneys with conservative management or interventional radiology, without operative exploration.

• Renal salvage was 100% for grade III–IV injuries managed conservatively or with interventional radiology.
• Across 151 patients with grade III or higher injuries, renal salvage was 69% and the initial management strategy succeeded in 82%.

For selected grade III–IV injuries, these findings support considering non-operative management instead of routine exploration at a trauma center; they do not establish safety for grade V injuries.