Levamisole-adulterated cocaine has increased in prevalence over the last decade and is known to be associated with antineutrophil cytoplasmic antibodies (ANCA). Dermatologic manifestations of levamisole exposure, including cutaneous vasculitis, are widely appreciated; less is known about its effects on the kidney. We report two cases of patients with a history of cocaine abuse and levamisole-induced cutaneous vasculitis, who developed acute kidney injury in the setting of elevated ANCA titers. Renal biopsies of both revealed pauci-immune complex glomerulonephritis with diffuse crescentic disease. These cases demonstrate a rare but serious complication of long-term cocaine use.