Acute tubular injury and Acute Interstitial Nephritis Secondary to Cocaine Use

Cocaine-associated kidney injury, such as acute kidney injury in the setting of rhabdomyolysis, have well been described in the literature. Acute interstitial nephritis (AIN) is a less frequent complication of cocaine intake. We present the case of a 37-year-old man who snorted cocaine and subsequently developed acute kidney injury in the absence of rhabdomyolysis. He underwent kidney biopsy which showed evidence of both AIN and ATI. He remained non-oliguric and euvolemic during his hospitalization. His renal function improved in two weeks with cessation of cocaine alone. No steroids were administered. In working up acute kidney injury, illicit drug history is important. We highlight the occurrence of cocaine associated ATI without heme pigment-induced AKI, and the presence of concurrent AIN. The clinical, biochemical and urinalysis findings are subtle and often, as in our case, are non-revealing. Renal biopsy is vital to diagnose these pathologies.