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The patient denied having taken cocaine in the last month due to his worsening general health&#44; but a urine sample was not taken to rule it out&#46; Haemodialysis was begun via a right jugular catheter with evident clinical improvement&#46; Of note in his medical history were 2 admissions to another hospital&#46; The first was 2&#46;5 years earlier due to a hypertensive emergency with acute pulmonary oedema requiring oral tracheal intubation and mechanical ventilation&#46; He was also suffering from acute renal failure with a plasma creatinine level of 5 mg&#47;dl in the context of rhabdomyolysis after inhaling cocaine&#46; Doppler echocardiography showed severe concentric hypertrophy of the left ventricle and moderately depressed systolic function&#46; The Doppler echocardiogram and catecholamine levels were normal&#46; Kidney function recovered completely without dialysis&#46; The second admission&#44; 6 months before this one&#44; was due to chest pain after consuming cocaine&#59; the level of troponin enzymes was normal&#44; but level of plasma creatinine of 2&#46;3 mg&#47;dl remained high&#46; Therefore&#44; the patient continued to take irbesartan&#44; amlodipine&#44; carvedilol&#44; and torsemide to control his blood pressure&#46; Later&#44; the patient stopped having medical check-ups&#46; Six months after beginning dialysis&#44; with no improvement in renal function&#44; a kidney biopsy was performed which showed that 10&#37; of the glomeruli had global sclerosis&#44; and the rest showed varying degrees of mesangial expansion&#44; 12&#37; with segmental hyalinosis&#44; and 40&#37; with moderate fibrosis of Bowman&#8217;s capsule&#46; The medium and small-sized arteries showed significant lumen reduction with hyalinization of the intima and media&#44; and intimal proliferation &#40;Figure 1&#41;&#46; Immunofluorescence was negative&#46; After 8 months without using cocaine&#44; the patient had stable blood pressure of 135&#47;85 mm Hg and needed treatment with 5 antihypertensive drugs and haemodialysis 3 times per week&#46;</p><p class="elsevierStylePara">The most common kidney complications due to cocaine abuse are rhabdomyolysis or severe AHT&#46;<span class="elsevierStyleSup">2</span>&#160;The mechanism linking cocaine with rhabdomyolysis is unclear&#44; but it could involve ischemia due to vasoconstriction and vasospasm caused by cocaine&#8217;s sympathomimetic action&#46; This triggers tissue hypoxia with myocytic necrosis&#44; direct muscle toxicity&#44; hyperpyrexia&#44; and an increase in muscle activity with repeated trauma due to the agitation after consumption&#46;<span class="elsevierStyleSup">2&#44;6 </span>Chronic cocaine use sets in motion chronic and haemodynamic changes mediated by the increase in oxidative stress and the stimulation of the renin-angiotensin system&#44; which lead to an increase in mesangial expansion&#44; tubulointerstitial fibrosis&#44; and greater atherogenesis&#46;<span class="elsevierStyleSup">4&#44;5</span>&#160;Furthermore&#44; chronic cocaine use can cause a permanent circle of vasoconstriction&#44; AHT&#44; and kidney failure&#46;<span class="elsevierStyleSup">7</span>&#160;Blood pressure can be extremely high and often related to the degree of kidney disease&#44; and it can be resistant to treatment&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">This is the first case in our hospital of chronic kidney failure with the need for replacement therapy due to cocaine use&#46; It is also worth highlighting in the patient&#8217;s medical history a proven episode of acute kidney failure due to rhabdomyolysis and severe&#44; hard-to-control AHT&#46; He also suffered from heart disease in the form of severe hypertrophy of the left ventricle with a depressed ejection fraction&#59; a pathology described in and related with cocaine consumption&#46; Besides&#44; cocaine is known to lead to ischaemic cardiomyopathy in the form of angina pectoris&#44; acute myocardial infarction&#44; and episodes of cardiac arrest due to arrhythmias&#44; even occurring in sporadic or one-off cocaine users&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">As nephrologists&#44; it is necessary to understand the extensive range of diseases that cocaine can produce in the kidneys&#44; taking into consideration its high&#44; ever-increasing rates of consumption&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10594&#95;108&#95;11439&#95;en&#95;10594&#95;18107&#95;8299&#95;es&#95;10594&#95;12002&#95;8299&#95;es&#95;fig&#95;1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10594_108_11439_en_10594_18107_8299_es_10594_12002_8299_es_fig_1.jpg" alt="Arteries with significant lumen reduction due to the hyalinization and proliferation of the intima and media"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Arteries with significant lumen reduction due to the hyalinization and proliferation of the intima and media</p>"
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