Chronic Renal Failure [CRF] is a progressive irreversible deterioration in renal function with a spectrum ranging from biochemical abnormalities [azotemia] to clinically evident abnormalities [uraemia] and end stage renal disease [ESRD]. The purpose of this paper is to highlight the significance of rare causes of CRF in the management of such patients. A case of a 26 year old male who had CRF with the only identifiable risk factor being abuse of recreational drugs alongside a review of relevant literature was studied. The patient presented with symptoms and signs in keeping with long standing impairment of renal function with causes traceable to his chronic abuse of cannabis and heroine. In the diagnosis, management, and follow-up of patients with chronic kidney disease, the importance of a detailed social history and life style modification cannot be overemphasized. We therefore recommend that appropriate diagnosis of CRF be made whenever it occurs and in the case of substance misuse, appropriate treatment given in that direction to relieve the disease.