A 36-year-old male presented with sudden pain in the left lower abdomen caused by a left renal infarction. Cocaine metabolites were found in the urine and a cocaine-induced renal infarction was diagnosed. Cocaine-induced renal infarction is not frequently reported in the literature. Pathophysiologic mechanisms include direct cocaine-induced platelet activation in combination with vasoconstriction and endothelial damage. There is no proven therapy for this complication.