A 31-year-old woman with well-controlled hypertension and metabolic syndrome developed acute kidney injury and a hypertensive emergency after ingesting psilocybin mushrooms. Her blood pressure reached 210/140, she experienced transient visual loss, and her troponin was elevated above 6000. Laboratory tests showed serum creatinine rising from a baseline of 0.9 to 4.6 mg/dL, proteinuria, and microscopic hematuria. A renal biopsy revealed vascular-predominant acute thrombotic microangiopathy. She was managed conservatively and did not require dialysis, but her kidney function only partially recovered, leaving a new baseline creatinine of 2.2-2.4 mg/dL and chronic kidney disease. Psilocybin can cause acute kidney injury leading to chronic kidney disease and secondary hypertension, possibly through vasoconstriction and endothelial damage.
A 40-year-old man developed life-threatening acute kidney injury after MDMA overdose, requiring dialysis. Kidney biopsy revealed two distinct causes: acute tubular necrosis from severe rhabdomyolysis and C3 glomerulopathy, a rare condition caused by dysregulation of the alternative complement pathway. Complement levels were low during the acute episode but normalized as kidney function recovered, and dialysis was discontinued at discharge. This case suggests that MDMA can trigger complement dysregulation leading to C3 glomerulopathy, which may resolve without specific complement-directed therapies. It underscores the need for broad diagnostic evaluation in drug-associated kidney injury.