The topic of renal trauma has offered many substantial and poignant issues of debate over the years, such as classification schemes, management techniques, imaging and diagnostic preferences, and post-traumatic sequelae. This overview presents the most recent and applicable arguments and data surrounding the treatment of renal trauma. Various classification structures have been proposed and utilized for over a century, yet they do not all focus on the different features of trauma presentation (pathogenesis, morphologic implications, symptoms, predisposing conditions) in an equal manner. The traditional controversy between observation and invasive surgery with trauma patients still exists, yet new methods of treatment protocol have been proposed for patients in traumatic shock. Concerning the state of the patient, it has been recognized that children with pretraumatic renal abnormalities are more prone to serious injury, but it is still undecided whether renal trauma will predispose a child to later pathologies such as arterial hypertension. Modern advances in imaging and diagnostic procedures have dramatically shifted the reliance on intravenous pyelograms to computed tomography, yet the question remains of how much imaging actually is needed in the average patient presenting with renal trauma. Pertinent issues such as these are presented, with main emphasis on literature published within the past 18 months.