A pinch of salt - A podcast by ERA

We watch creatinine rise and fall all the time, but a failing kidney allograft is more than a numbers game. Annelies de Weerd (Erasmus MC Rotterdam) covers when to call it failure, the immunosuppression taper, and helping patients through what feels like a step backwards.

Heart over there, kidney over here, metabolism somebody else’s problem? Not anymore. Amaryllis Van Craenenbroeck (KU Leuven) makes the case for Cardiovascular-Kidney-Metabolic syndrome as one continuum, not three separated clinics. Four drug classes, three organs, one patient, prevention upstream, and a fair hearing for the sceptics who call it disease-mongering.

For decades, “volume status” meant a (un)healthy dose of educated guessing. What if you could just look? Faeq Husain-Syed (Giessen) joins "A pinch of salt" to explain how kidney venous Doppler makes congestion visible, and whether Point-of-care Ultrasound is ready for prime time.

In acute heart failure, we’re told to take things with a pinch of salt but salt might be exactly what we should watch. Hugo Diniz welcomes Jozine ter Maaten, the principal investigator behind the PUSH-AHF trial, to argue heart failure is a sodium problem dressed as a fluid one — and why a rising creatinine may be a friend, not a foe.

Every nephrology trainee in Europe has heard about it, stressed about it, or is quietly pretending it doesn’t exist: the ESENeph. Is it a genuine European passport, or just one more exam? Hugo Diniz talks to David Lappin, about the exam’s format, its career value, and why trainees should sign up.

We obsess over PTH, calcium, and phosphate — yet our patients are quietly, inconveniently, fracturing. Hip fracture rates in dialysis patients dwarf the general population, and with very high mortality rates. Hugo Diniz asks Hanne Skou Jørgensen the uncomfortable question: have nephrologists been missing osteoporosis all along? DEXA’s comeback, bone turnover markers, and a practical screening algorithm.

For decades, treating IgA nephropathy meant looking thoughtful while saying "let's optimise supportive care and monitor closely." Not anymore. We've gone from one road to a full therapeutic roundabout, and nobody wants the wrong exit. Hugo Diniz welcomes Vlado Perkovic to navigate the new era: anti-APRIL and anti-BAFF agents, the VISIONARY and ORIGIN data, and the 2025 KDIGO framework. Are we finally switching off the disease at its source, or just admiring another elegant proteinuria curve? Vlado helps us separate evidence from excitement, and hype from hope. A new episode of A pinch of salt.

Are we all about to be replaced by chatbots? Probably not — but is there a risk of Gen-AI acute tubular necrosis for those who don't adapt? Hugo Diniz is joined by Wisit Cheungpasitporn to demystify what generative AI can actually do, expose what it definitely can't (yet), and make it approachable for every working nephrologist. From automating those soul-crushing clinic notes to navigating the constant flow of new evidence, "vibe coding" your own tools, and the dark side of energy use and patient privacy. AI may not replace your clinical judgment anytime soon — but it might just cure our chronic administrative disease.