Sirolimus is an immunosuppressive drug used to prevent graft rejection. Therapeutic drug monitoring is required as with other immunosuppressive drugs. Previous studies have shown the interactions between sirolimus and drugs that affect the activity of cytochrome P450 3A4 and P-glycoprotein. There is an increasing tendency for the use of herbal remedies in many countries. Medicinal herbs are rich sources of natural bioactive compounds that could interact with drugs. Parsley, Petroselinum crispum, is a food, spice, and also a medicinal herb. We report a case of a renal transplant recipient who had a supratherapeutic blood level of sirolimus due to consuming excessive parsley to highlight a possible herb–drug interaction. This is the first case report describing sirolimus–parsley interaction. Herb–drug interactions are especially important for drugs with a narrow therapeutic window. For this reason, healthcare professionals should question all patients, especially transplant patients, about the use of herbs or herbal products and report interactions. Plain Language Summary Parsley, a commonly consumed food, affects the level of an important drug in a renal transplant recipient: A case report Sirolimus is a drug that suppresses the immune response used to prevent organ rejection in people who have had kidney transplants. In order to reach the optimum balance between therapeutic efficacy and adverse effects, sirolimus blood levels should be closely monitored. Previous studies have shown the interactions between sirolimus and drugs that affect the activities of metabolizing enzymes and transporter proteins. Parsley is a food, spice, and also a medicinal herb. Medicinal herbs are rich sources of natural bioactive compounds that could interact with a prescription drug. We report a case of a renal transplant recipient who had a rise in the blood level of sirolimus due to the ingestion of an excessive amount of parsley to highlight possible herb–drug interaction.

Background In this study, we evaluated 3-month clinical outcomes of kidney transplant recipients (KTR) recovering from COVID-19 and compared them with a control group. Method The primary endpoint was death in the third month. Secondary endpoints were ongoing respiratory symptoms, need for home oxygen therapy, rehospitalization for any reason, lower respiratory tract infection, urinary tract infection, biopsy-proven acute rejection, venous/arterial thromboembolic event, cytomegalovirus (CMV) infection/disease and BK viruria/viremia at 3 months. Results A total of 944 KTR from 29 different centers were included in this study (523 patients in the COVID-19 group; 421 patients in the control group). The mean age was 46 ± 12 years (IQR, 37–55), and 532 (56.4%) of them were male. Total number of death was 8 [7 (1.3%) in COVID-19 group, 1 (0.2%) in control group; p = 0.082]. The proportion of patients with ongoing respiratory symptoms [43 (8.2%) vs. 4 (1.0%); p < 0.001)] was statistically significantly higher in the COVID-19 group compared to the control group. There was no significant difference between the two groups in terms of other secondary endpoints. Conclusion The prevalence of ongoing respiratory symptoms increased in the first three months post-COVID in KTRs who have recovered from COVID-19, but mortality was not significantly different.

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Background:Although focusing on the proliferative form of lupus nephritis (LN), recent reports also highlight the importance of recognizing and treating non-proliferative forms of LN.Objectives:In this study, we aimed to compare the clinical features and outcomes between proliferative and non-proliferative LN and to investigate the predictor factors of end stage renal disease (ESRD).Methods:This retrospective study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. 116 patients were diagnosed as LN. Biopsy findings had been classified according to the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) classification. Demographics, disease involvements, laboratory values, treatment regimens, and outcomes in LN course were compared according to the proliferative and non-proliferative LN. Complete renal response within first 24 months was defined as ACR response criteria. Factors predicting the ESRD were analysed by the logistic regression analysis.Results:A total of 116 lupus nephritis patients were categorised class 3 (n=17, 14.7%) or 4 (n=77, 66.4%) as proliferative LN and class 2 (n=9, 7.8%) or 5 (n=13, 11.2%) as non-proliferative LN. Of these patients, 80.2% was female. Mean age at the SLE diagnosis and SLE manifestations were similar for both group. ANA (+) ≥ 1:320, ds-DNA level, APS antibodies, anti-Sm (+) were similar for proliferative and non-proliferative LN, but ds DNA positivity and low level of C3 and C4 were more frequent in proliferative LN. LN duration was similar. Median renal SLEDAI scores were higher in proliferative LN group. Induction treatment regimens included pulse steroid 72.3%, CyC 51.8%, MMF 24.6%, Rtx 6.1%, CsA 4.4%, and plasma exchange 12.9%. ESRD, renal transplantation and exitus were major complications of LN. Predictors of ESRD were duration of lupus nephritis (OR 1.32 [1.09-1.61]; 95% CI), decrease in GFR at the biopsy time (OR 0.97 [0.95-0.99]; 95% CI), and being in complete renal response within 24 months (OR 21.07 [2.28-194.36]; 95% CI).Conclusion:Unfortunately, LN patients still have worse outcomes, such as high ESRD rate, regarding to current effective immunosuppressive treatment regimens. Although patients’ number were not enough for conclusion, interestingly, worse outcomes were not related with proliferative or non-proliferative LN. Complete remission within 24 months was most relevant good prognostic factor, and clinicians should be kept in mind to these windows of opportunity period.Table 1.Demographic, clinical characteristics, and outcomes of the patients with lupus nephritisVariables*All patients (n=116)Class 3 or 4 LN (n=94)Class 2 or 5 LN (n=22)pAge at the SLE diagnosis, years22.5±13.123±13.320.3±140.32Sex, female93 (80.2)74 (78.7)19 (86.4)0.42SLE disease duration8 (8.7)8 (9.7)8.3 (7.5)0.66Lupus nephritis at diagnosis time67 (58.8)54 (58.7)13 (59.1)0.97Manifestation of SLE-Musculoscletal75 (66.4)63 (68.5)12 (57.1)0.32-Mucocutaneous60 (52.6)50 (54.3)10 (45.5)0.45-Hematologic47 (40.9)38 (40.4)9 (42.9)0.83-Serosal26 (23.2)21 (23.1)5 (23.8)0.94-Neurological6 (5.3)5 (5.4)1 (4.8)0.91Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.6 (0.2)0.01-GFR (ml/min)110 (67)92 (55)145 (59)0.03-≥ 60 ml/min79 (79.8)63 (77.8)16 (88.9)-30-59 ml/min8 (8.1)7 (8.6)1 (5.6)0.55-< 30 ml/min12 (12.1)11 (13.6)1 (5.6)-24-hour urine protein≥ 1 gr/day72 (71.3)62 (76.5)10 (52.6)0.04≥ 3 gr/day36 (35.6)32 (39)4 (21.1)0.14-Active urinary sediment91 (83.5)78 (89.7)13 (59.1)0.001Renal SLEDAI at the biopsy12 (8)12 (8)8 (8)0.001Lupus nephritis duration (years)5.5 (8)5.1 (8.3)6.4 (4.8)0.73Complete renal response within 24 months69 (71.1)55 (72.4)14 (66.7)0.61End-stage renal disease13 (11.2)11 (11.7)2 (9.1)0.72Renal transplantation5 (4.3)4 (4.3)1 (4.5)0.95Exitus8 (7)7 (7.5)1 (4.5)0.62*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity indexDisclosure of Interests:None declared