BACKGROUND In this study, we evaluated the advantages and disadvantages of angioembolization in patients with Grade III-V blunt renal trauma compared with other treatments. MATERIAL AND METHODS We prospectively collected data on patients hospitalized for Grade III-V blunt renal trauma. Organ damage was graded according to the American Association for the Surgery of Trauma (AAST) criteria. Initial grouping was then performed according to the hemodynamics and "initial treatment". The eligible patients were divided into 3 groups: conservative treatment group (Group A), arterial embolization group (Group B), and surgical group (Group C). The success rate, significance, and follow-up renal function were evaluated. RESULTS In Group B of Grade IV, estimated glomerular filtration rate (eGFR) and serum creatinine (Scr) levels were slightly decreased and increased, respectively, after embolization compared with before embolization (P=0.002, P=0.039). In Grade V, the eGFR of Group B after embolization was lower than before embolization (P=0.041); The levels of serum urea (Urea) and Scr in Group B after treatment were higher than those before treatment (P=0.042, P=0.024). Conservative treatment and angioembolization were better than exploration in protecting renal function of Grade IV (P=0.035 and P=0.047, respectively). CONCLUSIONS The success rate of angioembolization was high and protected renal function to the greatest extent, and there were no differences in renal function at long-term follow-up. However, it is difficult to manage renal vessel laceration or avulsion by embolization alone, and various endovascular therapies are required to protect the function of residual kidneys.