MB and acute kidney injury: AKI results from the effect of the heme-containing compound, myoglobin, causing renal tubular obstruction, direct renal toxicity, renal ischemia, and decreased glomerular permeability [13]. Increased reactive oxygen species with MDMA metabolism and toxic oxidation and glutathione depletion may be responsible for direct tissue damage not only to the brain, liver, and heart but also to the kidneys (causing AKI) and muscles causing rhabdomyolysis [2,14]. Volume depletion also increases the nephrotoxic effect of rhabdomyolysis.