- What This Credential Actually Is
- The Eligibility Stack: Licensure, Hours, CME, Attestation
- Fees, Registration, and Pearson VUE Mechanics
- Exam Format and Test-Day Rules
- Reading the NCCPA Blueprint Correctly
- Domain-by-Domain Priorities
- The Six Task Categories Cross-Cut the Domains
- Official Preparation Resources
- Sequencing Your Preparation by Domain
- Ten-Year Validity and Maintenance
- Where the Credential Fits in Practice
- Frequently Asked Questions
- PA-CN here means NCCPA's Certificate of Added Qualifications in Nephrology (PA-C, CAQ-Neph), not initial PA-C certification or a nursing credential.
- Eligibility needs 4,000 total PA practice hours, including at least 2,000 in nephrology, within six years.
- The initial exam costs $350 total: $100 registration/administration plus $250 for the examination.
- Chronic Kidney Disease carries 20% of the blueprint, followed by End-Stage Renal Disease / Dialysis at 17%.
What This Credential Actually Is
The credential discussed on this site as "PA-CN" is the Certificate of Added Qualifications in Nephrology, issued by the National Commission on Certification of Physician Assistants (NCCPA). Holders use the designation PA-C, CAQ-Neph. "PA-CN" is a convenient alias used here for the same scope; the official title is the CAQ. If you want the naming background, see our explainers on what PA-CN is and what PA-CN stands for.
It helps to be precise about what it is not:
- It is not initial PA-C certification (the PANCE). You must already hold a current PA-C.
- It is not a nephrology nursing credential. Nurse practitioner nephrology certification, such as the CNN-NP offered by the Nephrology Nursing Certification Commission, is a separate pathway with its own specifications, none of which apply here.
- It is not a physician nephrology board examination.
The CAQ is a specialty add-on. It signals that a PA has documented nephrology experience, completed focused continuing education, had their practice attested by a knowledgeable colleague, and passed a specialty examination. For the broader overview, the PA-CN certification hub and the what is PA-CN certification primer cover the basics.
The Eligibility Stack: Licensure, Hours, CME, Attestation
Most candidates underestimate the paperwork. The exam is only one component; NCCPA awards the CAQ when you pass the specialty exam and complete the non-exam requirements. A fuller walkthrough is in our PA-CN requirements guide, but the core elements are:
Licensure and Certification
You need a current PA-C and unrestricted U.S. PA licensure, or unrestricted government-agency practice privileges. If you hold more than one license, all must be unrestricted.
Practice Hours
The experience requirement is 4,000 hours of total PA practice, including at least 2,000 hours in nephrology, within the six years before you attest that the requirement has been satisfied.
- Do not misread this as 4,000 nephrology hours. Only 2,000 must be nephrology-specific.
- The remaining hours may come from other PA practice.
Nephrology CME
You need 75 nephrology-focused Category I CME credits in the six years before exam application, with at least 25 earned in the preceding two years. ACLS is recommended but is not an additional mandatory course.
Procedural and Patient-Management Attestation
A collaborating physician, or a lead/senior PA who works in nephrology and knows your practice, completes the attestation. A physician or PA postgraduate program director may sign for a PA enrolled in or graduated from that program.
- It can be submitted before the exam or within 90 days after score notification.
- The form addresses relevant knowledge and performance, including management within at least one listed practice setting: end-stage renal disease, chronic kidney disease, kidney transplantation, or acute inpatient dialysis.
- It does not require a separate timed practical assessment, and you do not need employment in every nephrology subspecialty.
Fees, Registration, and Pearson VUE Mechanics
The initial fee is $350 total, made up of a $100 registration/administration fee and a $250 examination fee. Initial testing is delivered at Pearson VUE test centers. There is no remote option for the initial exam; online delivery exists only for maintenance exams (covered below). For a line-by-line look at budgeting, including CME and study materials, see the PA-CN certification cost breakdown, and for scheduling logistics see PA-CN exam dates and deadlines.
| Item | Detail |
|---|---|
| Registration/administration fee | $100 |
| Examination fee | $250 |
| Total initial fee | $350 |
| Optional NCCPA practice exam | $50 (separate from the exam fee) |
| Testing provider (initial exam) | Pearson VUE test centers |
| Score turnaround | Generally eight to ten weeks after administration, following validation |
Because scores are not instant, factor the eight-to-ten-week wait into any employer deadline, credentialing application, or title change you are hoping to time around the result.
Exam Format and Test-Day Rules
The initial exam contains 120 multiple-choice questions delivered in two 60-question blocks, with 60 minutes allotted per block. The two-hour exam timer excludes a 15-minute tutorial and a 15-minute break. Several rules shape how you should practice:
- Closed book. Personal calculators, notes, and books are prohibited.
- No revisiting finished blocks. Once you complete a block, you cannot return to its questions. Practice committing to answers within a block rather than relying on a second pass after you have moved on.
- Pacing math. Sixty questions in sixty minutes is roughly a minute per item, which suits clinical vignettes but punishes over-deliberation.
Since you cannot use a calculator, you should be comfortable reasoning through electrolyte and acid-base relationships, and estimating renal function concepts conceptually, rather than depending on computation tools. For perspective on how demanding the format feels, read how hard the PA-CN exam is.
Reading the NCCPA Blueprint Correctly
NCCPA publishes a three-page, undated Content Blueprint for the Nephrology CAQ Examination. No exam edition or effective year is stated, so do not assume a "2026 version" exists on the strength of article headlines. The blueprint has two separate lenses on the same exam, and mixing them up is a common mistake:
- Eleven medical content domains (what the question is about).
- Six task categories (what you are being asked to do).
The eleven domains are official medical content categories, not preparation-curriculum headings, and the examples beneath them are illustrative rather than exhaustive. Treat them as a map of exam coverage, not a syllabus that guarantees every question topic. One naming caution: at least one third-party summary labels the 20% category "Chronic Dialysis." The issuer's heading is Chronic Kidney Disease, and that is the label to study from.
For a full domain-by-domain treatment, see the complete guide to all 11 content areas.
Domain-by-Domain Priorities
| Domain | Weight |
|---|---|
| Chronic Kidney Disease | 20% |
| End-Stage Renal Disease / Dialysis | 17% |
| Renal Pathophysiology | 14% |
| Acute Kidney Injury/Intensive Care Unit Nephrology | 11% |
| Hypertension | 10% |
| Glomerular Disorders | 6% |
| Systemic Disorders | 6% |
| Tubulointerstitial/Viral Disorders | 5% |
| Kidney Transplantation | 5% |
| Vascular Disorders | 3% |
| Legal/Ethical Issues and Emerging Topics | 3% |
The top four domains account for 62% of the blueprint. The sections below translate the largest areas into concrete study targets.
Chronic Kidney Disease (20%)
The single largest category, and the one most closely tied to day-to-day outpatient nephrology and primary-care-adjacent practice.
- Staging and risk stratification concepts, and what changes in management at each stage
- Complications of progressive CKD: anemia, mineral and bone disorder, acidosis, hyperkalemia, volume management
- Slowing progression, including blood pressure and proteinuria strategies and medication dosing and avoidance in reduced kidney function
- Timing of referral, patient education, and preparation for kidney replacement therapy decisions
End-Stage Renal Disease / Dialysis (17%)
Expect questions that reward practical familiarity with dialysis care rather than textbook recall alone.
- Modalities and their trade-offs, including hemodialysis and peritoneal dialysis
- Vascular access considerations and access-related complications
- Adequacy concepts, interdialytic problems, and chronic dialysis complications
- Medication adjustment, nutrition, and bone-mineral management in dialysis patients
- Conservative kidney management and shared decision-making
Renal Pathophysiology (14%)
This is the foundational science layer that supports questions in every other domain.
- Fluid, electrolyte, and acid-base physiology and the logic of working through disturbances
- Tubular transport, diuretic mechanisms, and hormonal regulation of volume and pressure
- Interpreting urinalysis, urine chemistries, and the reasoning behind them
Acute Kidney Injury/Intensive Care Unit Nephrology (11%)
Think inpatient reasoning under time pressure.
- Differentiating prerenal, intrinsic, and postrenal causes from history, exam, and diagnostics
- Nephrotoxins, contrast, sepsis, and hemodynamic contributors
- Indications for urgent kidney replacement therapy and critical-care electrolyte emergencies
Smaller domains reward targeted review. In Glomerular Disorders, focus on distinguishing nephritic from nephrotic presentations and matching workup to likely diagnosis. In Kidney Transplantation, cover the PA-relevant essentials: immunosuppression principles, infection and malignancy surveillance, and drug interactions. In Systemic Disorders, review how diabetes, lupus, and other systemic diseases affect the kidney. In Legal/Ethical Issues and Emerging Topics, expect scenario-style questions on consent, end-of-life and conservative care decisions, and developments in the field.
The Six Task Categories Cross-Cut the Domains
The blueprint also distributes questions by what you are asked to do. These percentages describe the same 120 questions viewed through a different lens, so do not add them to the domain weights or treat them as extra content areas.
| Task Category | Weight |
|---|---|
| History and Physical | 7% |
| Diagnostic Studies | 20% |
| Diagnosis | 25% |
| Managing Patients (including Health Maintenance, Clinical Intervention, and Pharmaceutical Therapeutics) | 35% |
| Applying Scientific Concepts | 10% |
| Legal/Ethical Issues and Emerging Topics | 3% |
The practical takeaway: management is the heaviest task at 35%, and diagnosis plus diagnostic studies together reach 45%. Your preparation should therefore push beyond "what is this disease" toward "what do I order, how do I interpret it, and what do I do next, including drug choice and dosing in impaired kidney function." Candidates who only memorize disease descriptions tend to find the exam harder than expected, a point we examine in the PA-CN pass rate discussion, where we also explain why no verified specialty-specific pass rate is quoted.
Official Preparation Resources
Start with what NCCPA itself provides:
- Sample Nephrology Questions & Critiques (copyright 2024): worked examples with explanations of the reasoning behind correct and incorrect options. Read the critiques, not just the answers.
- Optional NCCPA practice exam ($50): one practice form is listed for this specialty, with a 180-day completion window. NCCPA describes the feedback as educational and not predictive of an exam pass, so use it to find weak domains rather than to forecast your result.
- The Content Blueprint: use it as a checklist for self-assessment.
A numeric passing threshold has not been verified from issuer sources, and commercial "pass guarantees" should be treated with skepticism. See our note on the PA-CN passing score for what is and is not publicly confirmed. To supplement official materials with timed, exam-style repetition, try the PA-CN practice tests.
Sequencing Your Preparation by Domain
Generic scheduling advice matters less than order. Because pathophysiology underpins the rest, a sensible sequence builds the foundation first and then moves to the heavily weighted clinical domains. The example below assumes an eight-week plan; compress or stretch it to your own timeline, and see the PA-CN study guide for a longer treatment.
Renal Pathophysiology and Hypertension
- Rebuild fluid, electrolyte, and acid-base reasoning without a calculator
- Review urinalysis and urine chemistry interpretation
- Cover hypertension mechanisms and drug classes in kidney disease
Chronic Kidney Disease and ESRD / Dialysis
- Work through CKD complications and progression-slowing strategies
- Study dialysis modalities, access, adequacy, and complications
- Practice renal dose adjustment for common medications
AKI/ICU Nephrology, Glomerular, Tubulointerstitial, Systemic, Vascular
- Drill the prerenal/intrinsic/postrenal framework
- Compare glomerular syndromes and their workups
- Review kidney involvement in systemic disease
Transplantation, Legal/Ethical, and Integration
- Cover transplant immunosuppression, surveillance, and interactions
- Review ethics and emerging-topic scenarios
- Take the NCCPA practice exam and two timed 60-question blocks with no backtracking
Since the exam is closed book and blocks cannot be revisited, simulate those conditions in your final two weeks. Spaced review of high-yield tables, such as diuretic sites of action or dialysis complications, fits naturally in the margins of this plan, and the PA-CN cheat sheet can serve as a quick-review companion.
Ten-Year Validity and Maintenance
The CAQ is valid for ten years as long as your PA-C and licensure remain current. Renewal requires 125 nephrology Category I CME credits earned during the cycle and submitted by the maintenance-exam application, plus passing the specialty examination. Older summaries citing 150 CME credits are not adopted here.
Key maintenance details:
- The governing policy (last reviewed May 2026) allows three maintenance attempts in years nine and ten.
- Maintenance can be taken at a test center or online.
- The online maintenance exam keeps the 120-question count but allows five minutes per question within an approximately six-week window. References are allowed; assistance from others is not.
- These online conditions apply to maintenance only. There is no remote option for the initial exam.
Where the Credential Fits in Practice
PAs with the nephrology CAQ typically work in settings that mirror the blueprint's own emphases: outpatient nephrology and CKD clinics, dialysis units, inpatient nephrology and critical-care consult services, and transplant programs. The attestation form itself names end-stage renal disease, chronic kidney disease, kidney transplantation, and acute inpatient dialysis as relevant practice settings, a useful hint about where employers expect experience. See PA-CN jobs for more on roles.
On compensation, no CAQ-specific salary premium has been verified, so we do not claim one. Pay in nephrology PA roles depends on setting, region, and experience, and any value from the credential may show up as credibility, role scope, or hiring preference rather than a guaranteed raise. Our salary guide and ROI analysis take that cautious approach, and your decision should rest on your own practice goals and employer expectations.
Frequently Asked Questions
NCCPA issues the Certificate of Added Qualifications in Nephrology, with the designation PA-C, CAQ-Neph. Initial testing is delivered through Pearson VUE test centers.
No. You need 4,000 hours of total PA practice, of which at least 2,000 must be in nephrology, within six years before you attest that the requirement has been satisfied.
The initial fee is $350 total: $100 for registration/administration and $250 for the examination. The optional NCCPA practice exam is a separate $50.
No. The initial exam is taken at a Pearson VUE test center, closed book, in two 60-question blocks. Online delivery is available only for maintenance exams.
Chronic Kidney Disease at 20%, followed by End-Stage Renal Disease / Dialysis at 17%, Renal Pathophysiology at 14%, and Acute Kidney Injury/Intensive Care Unit Nephrology at 11%.
Preparing for the PA-C, CAQ-Neph means treating the exam as one part of a larger process: confirm your hours and CME, line up your attester, learn the blueprint's domains and task categories, and practice under the closed-book, no-backtracking conditions you will face. When you are ready to test your recall under realistic timing, the practice test site offers a place to start.