Recreational drug use is a widespread activity in the young adult population. Cocaine and opioids have well described mechanism for renal toxicity, they include local and systemic toxicity, acute tubular necrosis, rhabdomylolysis and focal segmental glomerulosclerosis are among the most common presentations. We report a case of acute kidney injury in a young man after the recreational use of alcohol, cocaine and opioids, the pathological findings are described and a brief review of the literature is presented.