BackgroundThe consequences of cocaine use are multisystemic, such as, for instance, renal failure, hepatotoxicity and pulmonary toxicity, with renal alterations being the focus of the present study. The use of substances that modify the base composition of cocaine (or adulterants) aiming to potentiate its effects also has an impact on these manifestations. The present study aims to report three cases with different diagnosis of acute kidney injury related to cocaine use.Case presentationCase 01 - A 30-year-old female patient, who regularly used cocaine, started to have lower-limb edema, which showed a progressive and ascending evolution, affecting the face a few days later, associated with an isolated febrile episode and oligoanuria. The presence of cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) was verified: reactive 1:80, with renal biopsy compatible with rapidly progressive glomerulonephritis (RPGN). Case 02 - A 34-year-old female patient, with difficult-to-control hypertension and a frequent user of cocaine, showed generalized sudden edema together with diffuse and progressive pruritus associated with oliguria, fever, nausea, and vomiting. Schistocyte screening was positive, with negative direct Coombs test, and negative serologies for hepatitis B, C and HIV, as well as negative anti-double-stranded DNA, Anti-SSA and Anti-SSB. The renal biopsy was compatible with thrombotic microangiopathy, associated with moderate interstitial fibrosis and acute tubular necrosis Case 03 - A 25-year-old male patient who had been a cocaine user for 5 years had a sudden onset of generalized disabling myalgia (especially in the lower limbs) associated with recent frontotemporal headache, palpitation, dizziness, and a non-measured febrile episode; the patient had used cocaine at the night before symptom onset. CPK was 1731 U/L.The final probable diagnosis was AKI secondary to cocaine-induced rhabdomyolysis.ConclusionsIn conclusion basically, 05 etiologies of acute kidney injury should always be remembered: rhabdomyolysis, thrombotic microangiopathy, vasculitis, acute interstitial nephritis and renal infarction. Emphasis should be given to rhabdomyolysis due to its higher prevalence. Considering the increasing rates of cocaine use, especially with the use of adulterating substances, these pathologies will likely be increasingly prevalent.

A doença inflamatória intestinal (DII) possui etiologia incerta, mas fatores ambientais, genéticos e imunológicos podem juntos justificar a patogênese, clínica e prognóstico desses pacientes. A manifestação clínica é diversa, sendo o acometimento renal um dos mais prevalentes, quando se exclui o trato gastrointestinal. Ademais, o papel genético na DII já foi mostrado em diversos trabalhos, principalmente em irmãos monozigóticos. A indução e manutenção do tratamento de casos leves/moderados de pacientes em remissão clínica apresenta boa eficácia com o uso de ácido 5-aminosalicílicos (mesalazina). Essa medicação, apesar de raro, também pode levar ao acometimento renal, com a nefrite intersticial sendo uma das principais etiologias. A seguir, descrevemos o caso de irmãos monozigóticos portadores de DII que desenvolveram nefrite intersticial em vigência de tratamento com mesalazina.