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Primary renal aspergillosis is a very rare complication of AIDS which usually have fatal outcome (53% of mortality). The immune status of the patient and the early and correct therapeutic approach are the main factors that predict disease advancement. The new antiretroviral therapies improve the CD4 cell count and permit to treat these patients as immuno-competent. The local approach with antifungal drugs instillations, percutaneous drainage combined with systemic antifungal therapy can increase the number of patients that may benefit from a conservative treatment. We report a case of a 44-year-old homosexual patient with AIDS since 1991 in stage IVc (CDC--Centers for Disease Control and Prevention) in antiretroviral treatment. In September 1999 he came because of left low back pain. Laboratory data showed leucocytosis. Urinalysis revealed the presence of white and red blood cells and a negative urine culture. The abdominal ultrasound examination, the intravenous pyelogram and finally the computerized tomography confirm the presence of solid material that occupied the renal pelvis and the middle and superior caliceal group of the left kidney associated with lymph nodes enlargement. An echo-guided needle aspiration allowed us to identify Aspergillus fumigatus. Local instillations with amfotericina B through a nephrostomy and systemic antifungal drugs resolved the urinary infection.