Cardiovascular damage is common in young cocaine addicts, and similar atherosclerotic lesions seem likely in the kidneys. To confirm this hypothesis, we performed histological examination of 40 kidney autopsy specimens classified as "cocaine-related deaths"; as controls, kidney specimens of 40 road accident victims were examined. Semiquantitative analysis showed that the ratio of the number of glomeruli affected by hyalinosis to the total number of glomeruli was 0.09 +/- 0.13 in addicts and 0.005 +/- 0.01 in controls; the difference was highly significant. The degree of periglomerular fibrosis was significantly higher in cocaine addicts than in accident victims. The ratio of glomeruli to tubular casts was 0.15 +/- 0.17 in cocaine addicts and 0.17 +/- 0.18 in controls (not significant). The degree of interstitial cellular infiltration was significantly higher in addicts than controls. A monunuclear cell infiltrate was observed prevalently in the medullary region. Arteriolar sclerosis was significantly higher in addicts than controls. Medial thickening, luminal narrowing and vessel obstruction were absent in the control group. Quantitative morphometric analysis of arterial structure showed significantly greater lumen circumference, intima circumference, media circumference, intima area, media area, intima thickness and media thickness in cocaine addicts than in controls.