The treatment of renal trauma is evolving and increasingly focusing on the nonoperative and expectant management. In this review the ongoing controversy concerning the diagnosis and management of major blunt renal trauma shall be revisited. The contribution also includes a biomechanical approach for analyzing the renal injury mechanisms using a computer-simulated model of the kidney. In this connection, results of the modelling and simulations of the kidney subjected to the external forces shall be presented. Based on these findings a bending mechanism is postulated that may be responsible for renal injuries. Finally, the role of injury biomechanics research in the clinical management of trauma patients as well as in the area of injury prevention is discussed.