Replacement lipomatosis of the kidney is the result of severe atrophy or destruction of the renal parenchyma, often caused by calculous disease with secondary marked proliferation of renal sinus, renal hilus, and perirenal fatty tissue. Different diagnostic tools have been used to define this entity, with ultrasonography (US), i.v. pyelography (IVP) and computed tomography (CT) used most commonly. We report MR urography and MR appearance of replacement lipomatosis in a 38-year-old man. We think that it combines the advantages of IVP, US and CT.