Abstract: OBJECTIVE: To evaluate the severity and management of renal injuries during the Global War on Terror (GWOT) using the Department of Defense Trauma Registry (DODTR). METHODS: Data was analyzed from the DODTR from 2007-2023. Patients with renal injuries were identified using ICD-9 codes. Patients were evaluated on whether they underwent nephrectomy or observation as management. Descriptive and inferential statistics were used to characterize those undergoing observation vs nephrectomy. RESULTS: There were 707 patients identified with renal injuries that met inclusion. Casualties had a median age of 24 years. US Military accounted for 177 (25%) patients while 291 (41%) were humanitarian. 203 (29%) patients underwent nephrectomy and 504 (71%) were managed conservatively with observation. The nephrectomy group had a higher proportion of firearm mechanism of injury than the observation group (61% vs 29%). The abbreviated injury scale (AIS) category scores for the abdomen and pelvis were higher in the nephrectomy group. Patients undergoing nephrectomy consumed more crystalloid (5.6 L [interquartile range/IQR 3.2, 9.5] vs 3.5 L [IQR 1.1, 6.2]), red blood cells (8 units [IQR 3, 16] vs 2 units [IQR 0, 8]), and plasma (7 units [IQR 2,15] vs 2 units [IQR 0, 8]). Patients undergoing nephrectomy were more likely to have high-grade renal injuries (56% vs 8%, P < .001). CONCLUSION: The nephrectomy rate from combat-related renal injuries was high during the GWOT. More research is needed on combat-specific renal injuries to further improve guidelines, treatment strategies, and predeployment training.