BK polyomavirus nephropathy (BKVN) and allograft rejection are two closely-associated diseases on opposite ends of the immune scale in kidney transplant recipients. The principle of balancing the immune system remains the mainstay of therapeutic strategy. While patient outcomes can be improved through screening, risk factors identification, and rapid reduction of immunosuppressants, a lack of standard curative therapy is the primary concern during clinical practice. Additionally, difficulty in pathological differential diagnosis and clinicopathology’s dissociation pose problems for a definite diagnosis. This article discusses the delicate evaluation needed to optimize immunosuppression and reviews recent advances in molecular diagnosis and immunological therapy for BKVN patients. New biomarkers for BKVN diagnosis are under development. For example, measurement of virus-specific T cell level may play a role in steering immunosuppressants. The development of cellular therapy may provide prevention, even a cure, for BKVN, a complex post-transplant complication.

End-stage kidney disease (ESKD) is a global burden that reflects each country's unique condition. We used the National Health Insurance Research Database (NHIRD) of Taiwan to decipher changes in the mortality and international survival rates and to determine the effectiveness of the pre-end-stage renal disease care program (pre-ESRD care program) to guide future health policies for ESKD. We conducted a retrospective cohort analysis of the NHIRD data along with records from the catastrophic illness certificate program of ESKD patients from 2010 to 2018. From 2010 to 2018, the annual dialysis-related mortality rate in Taiwan increased from 10.6 to 11.8 deaths per hundred patient-years. The mortality rate for patients below 40 years appears to be decreasing, reflecting the improved quality of care for ESKD patients. Patients above 75 years showed increasing mortality, indicating the prolonged survival and aging of the ESKD population. Patients undergoing dialysis who participated in the pre-ESRD care program had a higher post-dialysis initiation life expectancy than those who did not participate. Among the program enrollees, the post-dialysis initiation life expectancy was higher in patients who had participated for more than one year. Taiwan has one of the highest ESKD patient survival rates globally. From 2010 to 2018, the reduced mortality in young patients and aging of the ESKD population might indicate that the quality of care in Taiwan for ESKD has improved. Furthermore, a better survival rate after dialysis initiation was observed in the pre-ESRD care program participants.

Acute kidney injury (AKI) causes a lot of harm to human health but is treated by only supportive therapy in most cases. Recent evidence shows that mesenchymal stem cells (MSCs) benefit kidney regeneration through releasing paracrine factors and extracellular vesicles (EVs) to the recipient kidney cells and are considered to be promising cellular therapy for AKI. To develop more efficient, precise therapies for AKI, we review the therapeutic mechanism of MSCs and MSC-derived EVs in AKI and look for a better understanding of molecular signaling and cellular communication between donor MSCs and recipient kidney cells. We also review recent clinical trials of MSC-EVs in AKI. This review summarizes the molecular mechanisms of MSCs’ therapeutic effects on kidney regeneration, expecting to comprehensively facilitate future clinical application for treating AKI.

Objectives: To review the outcomes of patients who underwent repeated vertebroplasty (VP) surgery for adjacent segment fractures (ASF), defined as new osteoporotic vertebral fractures occurring at levels immediately above or below a previously treated vertebra. Methods: From 1 January 2018, to 31 December 2020, forty-one patients who developed ASF following initial VP and underwent repeated VP were enrolled in our study. Radiographic measurements included single and two-segment kyphotic angles (SKA and TKA), and anterior and mid-vertebral body height (AVH and MVH). Patient-reported outcomes included back pain assessed with the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results: The procedure significantly reduced the mean single kyphotic angle (SKA) by 4.8° ± 6.8° (p < 0.01) and the two-segment kyphotic angle (TKA) by 3.0° ± 7.9° (p = 0.02), along with increases in anterior and mid-body height by 0.3 ± 0.5 cm and 0.3 ± 0.6 cm (both p < 0.01). However, there was a slight restoration loss in SKA and TKA at a 20.1-month follow-up. Patient-reported outcomes revealed substantial pain reduction, with the VAS score dropping from 8 to 1 (p < 0.0001) and the mean ODI score improving from 59.7 to 28.9 (p < 0.0001). The complication rate was 34.1%, including nonunion, de novo fractures, cement leakage, and neurological deficits. Additionally, 7.3% of cases necessitated further surgical interventions. Conclusions: Repeated VP for ASF improves vertebral alignment parameters and patient-reported outcomes, but with a high rate of complications and reoperation.