The current management of blunt trauma of the kidney is based on the 5-grade classification of lesions established by the ASST (American Society of the Surgery of Trauma). The indications for imaging are now clearly defined and spiral CT represents the reference examination. Over the last decade, the debate concerning the management of severe trauma has divided the supporters of surgical treatment from those who recommended conservative management. The contribution of interventional radiology and endourological treatments and the efficacy of intensive care now limit the complications related to trauma and reduce the need for surgery. However, the morbidity related to trauma is considerable in the presence of fragments of devascularized renal parenchyma, urine extravasation and associated lesions. These complications can be anticipated by a better definition of the traumatic lesions. The American classification presents certain limitations in relation to these combinations of poor prognostic factors. This review was designed to define the most recent biomechanical considerations, the place of imaging and finally the indications and results of management of blunt trauma of the kidney, in the light of the data of the literature.