- What This Credential Actually Is
- Eligibility Snapshot
- Exam Format and Test-Day Rules
- Fees, Scoring Timeline, and Award
- The 11 Content Categories at a Glance
- The Six Task Categories (A Second Lens)
- High-Yield Nephrology Topics to Drill
- Official Practice Materials
- Sequencing Your Review by Domain Weight
- Ten-Year Validity and Renewal Rules
- Quick-Answer FAQ
- The exam is 120 multiple-choice questions in two 60-question, 60-minute blocks; finished blocks cannot be revisited.
- Initial fee is USD $350: $100 registration/administration plus $250 for the examination, taken at Pearson VUE.
- Eligibility needs 4,000 total PA hours, with at least 2,000 in nephrology, plus 75 nephrology Category I CME credits.
- Chronic Kidney Disease (20%) and End-Stage Renal Disease / Dialysis (17%) together cover over a third of content.
What This Credential Actually Is
"PA-CN" on this site is shorthand for 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. It is a specialty credential layered on top of initial PA-C certification, so it is not the PA-C itself, not a nephrology nursing credential, and not a physician nephrology board exam.
If you are still orienting yourself, our explainers on what PA-CN is and what PA-CN stands for cover the naming in more depth. This cheat sheet assumes you already know the basics and want the facts compressed onto one page.
Eligibility Snapshot
The full walkthrough lives in our PA-CN requirements guide. Here is the condensed checklist:
- Certification and licensure: a current PA-C and unrestricted U.S. PA licensure (or unrestricted government-agency practice privileges). All licenses you hold must be unrestricted.
- Practice hours: 4,000 total PA practice hours, including at least 2,000 in nephrology, within six years before you attest that the experience requirement is satisfied. The 4,000 figure is total PA practice, not nephrology-only hours.
- CME: 75 nephrology-focused Category I CME credits in the six years before exam application, with at least 25 in the preceding two years.
- ACLS: recommended, not an additional mandatory course.
- Attestation: signed by a collaborating physician or lead/senior PA who works in nephrology and knows your practice. A physician/PA postgraduate program director may sign for a PA enrolled in or graduated from that program.
- Window: the initial CAQ process must be completed within six years after initiation.
Attestation Details Candidates Overlook
The attestation form addresses relevant knowledge and performance, including management within at least one listed nephrology practice setting.
- Listed settings: end-stage renal disease, chronic kidney disease, kidney transplantation, or acute inpatient dialysis
- You need competence in at least one setting, not employment across every nephrology subspecialty
- No separate timed practical assessment is required
- It may be submitted before the exam or within 90 days after score notification
Exam Format and Test-Day Rules
The initial exam is delivered at Pearson VUE test centers. There is no remote option for initial testing; online delivery exists only for maintenance exams (covered below).
| Feature | Initial CAQ Exam |
|---|---|
| Total questions | 120 multiple-choice |
| Structure | Two blocks of 60 questions |
| Time | 60 minutes per block (two hours of testing) |
| Extras not counted in the timer | 15-minute tutorial and 15-minute break |
| Reference materials | Closed book; no personal calculators, notes, or books |
| Revisiting questions | Not allowed once a block is finished |
| Location | Pearson VUE test center |
Two practical consequences follow. First, with 60 minutes for 60 questions, you have roughly a minute per item, so you must decide and move on rather than agonize. Second, because you cannot return to a finished block, use the in-block review features before you submit it, and do not leave questions blank intending to come back later.
Key Takeaway
Closed book means every formula, threshold, and diagnostic pattern must live in your memory. Practice mental estimation of anion gaps, fractional excretion logic, and dosing adjustments without a calculator, since personal calculators are prohibited.
For a candid look at how this format feels in practice, see how hard the PA-CN exam is.
Fees, Scoring Timeline, and Award
| Item | Detail |
|---|---|
| Registration/administration | $100 |
| Examination | $250 |
| Initial total | $350 |
| Optional practice exam | $50 (NCCPA) |
| Score reporting | Generally eight to ten weeks after administration, following validation |
| Award requirement | Passing specialty-exam result plus completion of non-exam requirements |
Budget planning, including CME and the optional practice exam, is broken down in our PA-CN certification cost guide. Scheduling mechanics and deadlines are addressed in PA-CN exam dates.
Be careful about numeric claims you may see elsewhere. NCCPA materials reviewed for this article did not verify a numeric passing threshold or an official specialty-specific pass rate, so treat any commercial pass-rate or pass-guarantee claim with skepticism. Our pages on the passing score and pass rate explain what can and cannot be stated responsibly.
The 11 Content Categories at a Glance
NCCPA's content blueprint for the nephrology CAQ lists eleven medical content categories. The illustrative examples beneath each heading in the blueprint are examples, not exhaustive lists, and the headings describe what is tested rather than how you should structure your studying. The blueprint is a three-page, undated document, so no particular edition year should be assumed.
| # | Content Category | Weight |
|---|---|---|
| 1 | Chronic Kidney Disease | 20% |
| 2 | Glomerular Disorders | 6% |
| 3 | Tubulointerstitial/Viral Disorders | 5% |
| 4 | Vascular Disorders | 3% |
| 5 | Systemic Disorders | 6% |
| 6 | Kidney Transplantation | 5% |
| 7 | Hypertension | 10% |
| 8 | Renal Pathophysiology | 14% |
| 9 | Acute Kidney Injury/Intensive Care Unit Nephrology | 11% |
| 10 | End-Stage Renal Disease / Dialysis | 17% |
| 11 | Legal/Ethical Issues and Emerging Topics | 3% |
For a category-by-category treatment, see the complete guide to all 11 PA-CN content areas.
What the weights tell you
- Top four categories: Chronic Kidney Disease (20%), End-Stage Renal Disease / Dialysis (17%), Renal Pathophysiology (14%), and Acute Kidney Injury/Intensive Care Unit Nephrology (11%) together account for 62% of the content.
- Hypertension at 10% is a single category that rivals the weight of AKI/ICU nephrology, so it deserves real study time rather than assumed familiarity.
- The four small clinical categories (Glomerular 6%, Systemic 6%, Tubulointerstitial/Viral 5%, Kidney Transplantation 5%) plus Vascular (3%) and Legal/Ethical (3%) total 28%. Individually small, collectively significant.
The Six Task Categories (A Second Lens)
The same exam is also classified by the kind of task each question asks you to perform. This is a cross-classification of the same 120 questions, not six additional medical domains, and these percentages must never be added to or merged with the content weights above.
| 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% |
Key Takeaway
Managing Patients carries 35%, so expect many questions that ask what to do next: which medication to start, adjust, or avoid; when to refer or intervene; what to monitor. Knowing a disease is not enough. Practice choosing the best next management step.
High-Yield Nephrology Topics to Drill
The blueprint's examples are illustrative, so use the following as a framework for the kinds of competencies a nephrology PA is expected to apply, organized by the official categories. Confirm specifics against the blueprint and your clinical references.
Chronic Kidney Disease (20%)
The largest category rewards longitudinal-care thinking.
- Staging, progression, and the albuminuria and eGFR concepts behind risk stratification
- Complications management: anemia, mineral and bone disorder, acidosis, hyperkalemia
- Medication dosing and avoidance in reduced kidney function
- Preparing patients for kidney replacement therapy decisions
End-Stage Renal Disease / Dialysis (17%)
Modality and access knowledge, plus complication recognition.
- Hemodialysis versus peritoneal dialysis considerations
- Vascular access types and their complications
- Dialysis adequacy concepts and common intradialytic problems
- Long-term complications and patient education
Renal Pathophysiology (14%)
The "why" behind the lab values and exam findings.
- Acid-base and electrolyte physiology
- Tubular transport and diuretic mechanisms
- Volume regulation and urine studies interpretation
- Mechanism-based reasoning for diagnostic and therapeutic choices
Acute Kidney Injury/Intensive Care Unit Nephrology (11%)
Differentiating causes and acting under time pressure.
- Prerenal, intrinsic, and postrenal frameworks
- Indications and timing considerations for urgent kidney replacement therapy
- Critical-care electrolyte and acid-base emergencies
- Nephrotoxin recognition and avoidance
Hypertension (10%)
More than a general-medicine refresher in a nephrology setting.
- Secondary hypertension workups relevant to kidney disease
- Antihypertensive selection in CKD and dialysis populations
- Resistant hypertension reasoning
The remaining categories reward pattern recognition: glomerular presentations and what workup distinguishes them, tubulointerstitial and viral-related kidney disease, vascular disorders, systemic diseases with renal involvement, kidney transplantation care (immunosuppression issues, rejection and infection concerns), and the legal/ethical and emerging-topic questions that make up a small but real 3%.
Official Practice Materials
- Sample Nephrology Questions & Critiques: NCCPA's free sample-question document (copyright 2024). Work through the critiques, not just the answers, because the rationales reveal how questions are framed.
- NCCPA practice exam: optional, $50, one practice form for this specialty, with a 180-day completion window. NCCPA notes that its educational feedback does not predict whether you will pass the actual exam, so use it to find weak spots, not to forecast your result.
Build a broader plan from our PA-CN study guide, and when you want timed, exam-style repetition, use the practice questions on the main PA-CN practice test site.
Sequencing Your Review by Domain Weight
One approach that ties the blueprint directly to your calendar: spend your longest, earliest blocks on the heaviest categories, then cycle back through everything under timed conditions. The eight-week layout below is a sketch, so adjust it to your clinical schedule and baseline strengths.
Chronic Kidney Disease and ESRD / Dialysis
- 37% of content combined, so start here
- Run through the NCCPA sample critiques for these topics
- Memorize drug-dosing and complication-management patterns without a calculator
Renal Pathophysiology and AKI/ICU Nephrology
- Reinforce acid-base, electrolyte, and urine-study reasoning
- Practice differentiating AKI etiologies quickly
Hypertension, Glomerular, Systemic, Tubulointerstitial/Viral, Vascular, Transplantation
- Group the smaller categories by presentation patterns
- Focus on next-step management in each
Timed mixed review
- Take the optional NCCPA practice exam in two 60-minute blocks
- Review Legal/Ethical Issues and Emerging Topics
- Rework every missed concept
Ten-Year Validity and Renewal Rules
The CAQ is valid for ten years as long as your PA-C certification and licensure remain current. Renewal has two components: 125 nephrology Category I CME credits earned during the cycle and submitted by the maintenance-exam application, plus passing the specialty examination.
- The May 2026 governing policy allows three maintenance attempts in years nine and ten.
- Maintenance can be taken at a test center or online.
- The online maintenance exam keeps 120 questions but allows five minutes per question within an approximately six-week window. References are allowed; assistance from others is not.
Online delivery and open-reference rules apply only to maintenance, not to your initial exam. To weigh the long-term value of keeping the credential, read whether the PA-CN certification is worth it, and see PA-CN jobs for where the credential fits in hiring. Because no CAQ-specific salary figures were verified for this article, our salary guide treats earnings qualitatively rather than assuming a pay premium.
Quick-Answer FAQ
At least 2,000 nephrology hours, as part of 4,000 total PA practice hours, within six years before you attest that the experience requirement is satisfied. The 4,000 is total PA practice, not nephrology-only.
No. The initial exam is delivered at Pearson VUE test centers. Online delivery with open references is available only for maintenance exams, not initial certification.
Chronic Kidney Disease at 20%, followed by End-Stage Renal Disease / Dialysis at 17%, Renal Pathophysiology at 14%, and AKI/Intensive Care Unit Nephrology at 11%.
No. The six task categories cross-classify the same exam. They are a second way of describing the same questions and should not be added to the eleven medical content weights.
A numeric passing threshold and an official specialty-specific pass rate were not verified from NCCPA sources. Be cautious of any site quoting precise figures or guaranteeing a pass.
That is the full one-page picture: the credential's identity, the eligibility math, the exam mechanics, both weighting lenses, and the renewal rules. Bookmark this page, verify anything time-sensitive on NCCPA's site, and revisit the PA-CN certification overview as you move from planning to scheduling.