RESUMO
Acute renal insufficiency associated to cocaine consumption is well known, and normally secondary to rhabdomyolisis. The possibility that renal failure is related to hypertension and to renal histopathological findings indistinguishable of other malignant hypertension conditions is a not as well known fact. Certain derivatives of cocaine are powerful vasospasm inducers, which could be the key of the origin of the ischemic lesions that appears not only in the kidney but in other organs, especially in the nervous system. We present four patients with acute renal insufficiency, two of them because of malignant hypertension, another one because of cocaine consumption with very severe ischemic neurological lesions, but reversible with the withdrawal of the drug, and another one because of rhabdomyolisis. The latest patient had a different evolution probably related to the different habit of consumption and perhaps as a consequence of different derivatives of cocaine.