We present 2 cases of magnetic resonance imaging in hemorrhagic fever with renal syndrome and their histopathologic findings. The low signal intensities along the renal outer medulla in T2-weighted images are persistent ex vivo as well as in vivo, and these are the radiologic counterpart of medullary congestion and hemorrhage. We will discuss the significance of the imaging in the fields of the medical renal disease such as acute renal failure and review the mechanisms of acute renal failure in hemorrhagic fever with renal syndrome.