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.

This is “A pinch of salt” live from the 63rd ERA Congress! Recorded straight out of a packed Clyde Plenary Room: six trials, ninety minutes! Hugo Diniz, the new podcast host, brings you rapid-fire expert commentary with two titans of European nephrology, Alberto Ortiz and Danilo Fliser. On the menu — a brand-new CKD drug class (nurandociguat), what patients actually feel on semaglutide (FLOW sub-analysis), two IgA nephropathy therapies going long-term (atrasentan and iptacopan), anticoagulation in advanced kidney disease (TRACK), and the first randomised trial of dialysis versus conservative care. An episode you just can’t miss!

In the 75th episode of A Pinch of Salt we'll be talking about narrative-based medicine, a topic that is not specific to nephrology, but it should be a core topic that is deeply involved in practicing patient-friendly clinical medicine. In medical schools we are taught extensively on how to get information from patients about their symptoms and signs, which will help us develop a differential diagnosis. But we don’t learn much about how to get information on the patient’s point of view, their ideas, concerns and expectations. We are also not always well equipped to communicate important medical information to patients in a manner that would be understandable to them and also meaningful. Narrative-based medicine is an approach to healthcare that emphasizes understanding a patient’s story—not just their symptoms or test results—as a central part of diagnosis and treatment. It is also a very useful  tool that helps you to communicate effectively back to the patient. It is often not helpful to define a patient’s medical reality by using the language of science, as this is understood only by scientists and virtually nobody else. Learn how to incorporate stories in your clinical practice. It will benefit both you and your patients.

In this episode we are joined by Peter Stenvinkel to discuss why Chronic Kidney Disease is increasingly recognized as a state of "fast-forward" aging. 
We dive into: The "Inflammaging" Factor- How chronic low-grade inflammation acts as a silent driver of vascular disease and frailty, the cellular Senescence: Exploring the gut-kidney axis and the "zombie cells" that stall recovery and clinical Intervention: Practical strategies for clinicians to monitor biological age and improve both quality and length of life.