Well, realistic and modern are two completely different animals. A MUD can have a modern setting that's completely fantastic while a historical MUD set in the Middle-Ages can be as realistic as possible.
Now, if by realistic you mean featuring as many aspects of the "real world" (death, injuries, economics, politics, etc.) as the corporeal existance you've come to know and love regardless of setting, there are a few out there. Not sure if any have a setting placed firmly in the 21st (or even 20th) Century though.
For a very realistic world, I recommend Harshlands, Shadows of Isildur, and Armageddon. While all three are fantasy settings, the experience is as close to "realism" as you'll find on a MUD. No levels, experience points, or other game-like stuff.
Take care,
Jason
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