40 cases of major renal trauma over a period of five years in a peripheral hospital in Singapore were reviewed. 90% were due to blunt trauma with motor-cycle accidents forming the majority. There were five cases of superficial cortical injury, three cases of shattered kidneys, six cases of parenchymal injuries, one case of pedicle injury and one case of combined pedicle and parenchymal injury. Nephrectomy rate was 22.5% in this series. This is felt to be unduly high. Half of all the cases operated upon ended up with an immediate total nephrectomy. There was no mortality in this series. We recommend a more conservative policy of watchful waiting to achieve better chances of organ preservation without increasing mortality.