The agony of ecstasy: MDMA (3,4-methylenedioxymethamphetamine) and the kidney

Clin J Am Soc Nephrol. 2008 Nov;3(6):1852-60. doi: 10.2215/CJN.02080508. Epub 2008 Aug 6.


Ecstasy (MDMA, 3,4-methylenedioxymethamphetamine) is commonly used by college-aged individuals. Ecstasy leads to feelings of euphoria, emotional empathy, and increased energy. These effects come at a significant risk for complications. Ecstasy has been associated with acute kidney injury that is most commonly secondary to nontraumatic rhabdomyolysis but also has been reported in the setting of drug-induced liver failure and drug-induced vasculitis. More common, ecstasy has led to serious hyponatremia and hyponatremia-associated deaths. Hyponatremia in these cases is due to a "perfect storm" of ecstasy-induced effects on water balance. Ecstasy leads to secretion of arginine vasopressin as well as polydipsia as a result of its effects on the serotonergic nervous pathways. Compounding these effects are the ready availability of fluids and the recommendation to drink copiously at rave parties where ecstasy is used. The effects of ecstasy on the kidney as well as therapeutic measures for the treatment of ecstasy-induced hyponatremia are presented.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Female
  • Hallucinogens / adverse effects*
  • Humans
  • Hyponatremia / chemically induced*
  • Hyponatremia / metabolism
  • Hyponatremia / therapy
  • Kidney / drug effects*
  • Kidney / metabolism
  • Kidney / physiopathology
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / metabolism
  • Kidney Diseases / therapy
  • Male
  • N-Methyl-3,4-methylenedioxyamphetamine / adverse effects*
  • Syndrome
  • Water-Electrolyte Balance / drug effects*
  • Young Adult


  • Hallucinogens
  • N-Methyl-3,4-methylenedioxyamphetamine