Aim: To highlight the validity of MSCT in predicting the efficacy of non-operative management in patients with high grade blunt renal trauma using American Association for the Surgery of Trauma (AAST) renal injury scale Patients and methods: Through a prospective study included 39 patients with high grades blunt renal traumas (grade III, IV and V), MSCT was done for all included cases and correlated to AAST grading system then we followed up non-operated cases by clinical, laboratory and US for all cases and CT in 12 cases along two weeks period. Statistical analysis was done for planed management immediately after CT and proper management done through two weeks of follow up. Results: MSCT graded the injury into grade III, IV and V according to AAST grading system presented in 48.7%, 33.3% and 17.9 % respectively. 74.4% of cases underwent conservative management, 5.1% underwent immediate surgical nephrectomy, 7.7 % underwent intervention embolization and double J fixation was done in 7.7%. Within 2 weeks of follow up conservative management was sufficient  in only 64.1% as some patients developed other predisposing factors demanded further interventions and a total percentage of 17.9% of our cases underwent surgical laparotomy (6 cases nephrectomy and one case renorrhaphy), surgical percutaneous drainage of urinoma in  one case and renal artery embolization raised to 10.3% of our cases. Conclusion: MSCT can determine the exact criteria for selecting patients for conservative management in hemodynamic stable patients. Non-operative management strategy in line with repeated imaging and close clinical follow up salvaged the affected kidney in most of the cases.