- What a PA-CN Actually Is
- Who Issues It and What the Letters Mean
- Who Can Sit for It
- What the Exam Looks Like
- What the Exam Covers
- The Second Lens: Tasks, Not Topics
- Fees, Attestation and Timeline
- Keeping the Certificate for Ten Years
- Sequencing Your Preparation
- Where the Credential Fits at Work
- Frequently Asked Questions
- PA-CN is a site alias for NCCPA's Certificate of Added Qualifications in Nephrology, designated PA-C, CAQ-Neph.
- Eligibility needs 4,000 total PA hours, with at least 2,000 in nephrology, within six years.
- The exam has 120 multiple-choice questions in two 60-minute blocks; finished blocks cannot be revisited.
- Chronic Kidney Disease is the largest content category at 20%, followed by End-Stage Renal Disease / Dialysis at 17%.
What a PA-CN Actually Is
If you have seen "PA-CN" on this site or in a search result, it refers to the Certificate of Added Qualifications in Nephrology, a specialty credential for physician associates and physician assistants. The official designation a successful candidate earns is PA-C, CAQ-Neph. "PA-CN" is simply the shorthand used here for that credential.
That definition matters because the acronym is easy to confuse. This is not initial PA-C certification, which every candidate must already hold. It is not a nephrology nursing credential, and it is not a physician nephrology board examination. It is an added layer for PAs who already practice in kidney care and want to document specialty-level knowledge through a standardized exam. For the other common phrasings of the question, see our explainers on what PA-CN is and what PA-CN stands for.
Who Issues It and What the Letters Mean
The issuing body is the National Commission on Certification of Physician Assistants (NCCPA), the same organization that certifies PAs generally. Initial testing is delivered at Pearson VUE test centers. The official program page lives on NCCPA's specialty certificates section, and the governing document is its policy on the Certificates of Added Qualifications program.
The letters break down simply: "PA-C" is the general certification, and "CAQ-Neph" signals the nephrology certificate. Earning the certificate requires two things together: a passing result on the specialty exam and completion of the non-exam requirements described below. Passing the exam alone does not award the certificate. For a broader overview of the credential, see PA-CN certification.
Who Can Sit for It
The prerequisites are specific, and the most commonly misread one is the hours requirement. Candidates need:
- A current PA-C certification.
- Unrestricted U.S. PA licensure or unrestricted government-agency practice privileges, with every license you hold unrestricted.
- 4,000 hours of total PA practice, including at least 2,000 hours in nephrology, within the six years before you attest that the experience requirement is satisfied. This is not 4,000 nephrology hours.
- 75 nephrology-focused Category I CME credits in the six years before exam application, with at least 25 of them in the preceding two years.
ACLS is recommended but is not an additional mandatory course. The full walkthrough is in our PA-CN requirements guide.
The Procedural and Patient-Management Attestation
A collaborating physician, or a lead or senior PA who works in nephrology and knows your practice, attests to your procedural and patient-management skills. A physician or PA postgraduate program director may sign instead for a PA who is enrolled in or has graduated from that program. The form covers 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.
Two details reassure candidates. There is no separate timed practical assessment, and you are not required to work in every nephrology subspecialty. The attestation can be submitted before the exam or within 90 days after score notification, and the whole initial CAQ process must be completed within six years of starting it.
What the Exam Looks Like
The initial exam is 120 multiple-choice questions split into two 60-question blocks with 60 minutes per block. The two-hour timer excludes a 15-minute tutorial and a 15-minute break. Testing is closed book: personal calculators, notes, and books are not allowed.
| Feature | Initial PA-CN Exam |
|---|---|
| Question count | 120 multiple-choice |
| Structure | Two 60-question blocks |
| Time | 60 minutes per block (tutorial and break excluded) |
| Reference materials | None; closed book |
| Review rule | Cannot revisit questions in a finished block |
| Delivery | Pearson VUE test center |
The no-revisit rule shapes strategy. Because you cannot return to a completed block, pacing and committing to answers matter more than they would on an exam with open navigation. Candidates who like to skip and circle back have to adapt within each block. For a sense of how demanding this setup feels, read how hard the PA-CN exam is.
What the Exam Covers
NCCPA publishes a three-page content blueprint listing eleven medical content categories. The blueprint is undated, so no exam edition or effective year should be inferred. The examples beneath each category are illustrative, not exhaustive.
| 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% |
One labeling note: a third-party summary calls the 20% category "Chronic Dialysis." The issuer's own heading is Chronic Kidney Disease, and that is the name to trust. The full breakdown is in our guide to all 11 PA-CN content areas.
Chronic Kidney Disease (20%)
The largest slice. Expect questions on the long arc of CKD care rather than a single decision point.
- Staging and progression, and how findings should shape management
- Complications of reduced kidney function and their treatment
- Medication choices and adjustments in a patient with impaired clearance
End-Stage Renal Disease / Dialysis (17%)
The second-largest category, and one that rewards hands-on dialysis exposure.
- Modality considerations and the day-to-day management of dialysis patients
- Complications seen in the dialysis population
- Planning around the transition to kidney replacement therapy
Renal Pathophysiology (14%)
The mechanism-level material. These questions test why a disturbance happens, not just how to treat it.
- Fluid, electrolyte, and acid-base reasoning
- Normal renal physiology as the baseline for interpreting abnormal findings
Acute Kidney Injury/Intensive Care Unit Nephrology (11%)
Acute care scenarios where recognition and sequencing of actions matter.
- Distinguishing the causes of acute injury
- Nephrology decisions in critically ill patients
Hypertension (10%) deserves separate attention because it bridges primary care and nephrology thinking, and the smaller categories, such as Kidney Transplantation and Glomerular Disorders, are where narrow specialty knowledge can separate candidates.
The Second Lens: Tasks, Not Topics
The same 120 questions are also classified by what you are being asked to do. This is a separate distribution that cross-classifies the exam. It does not add six more medical domains, and the percentages cannot be added to the content weights above.
| Task | Weight |
|---|---|
| Managing Patients (including Health Maintenance, Clinical Intervention, and Pharmaceutical Therapeutics) | 35% |
| Diagnosis | 25% |
| Diagnostic Studies | 20% |
| Applying Scientific Concepts | 10% |
| History and Physical | 7% |
| Legal/Ethical Issues and Emerging Topics | 3% |
The practical meaning: management dominates. A single question might sit in the Chronic Kidney Disease domain and test a Managing Patients task, such as choosing a therapy. Studying only disease facts without practicing "what do you do next" decisions leaves the biggest task category underprepared.
Key Takeaway
Think of the blueprint as a grid. Domain tells you which kidney topic, and task tells you which clinical skill. Prepare each topic in all of the ways it can be asked, with extra emphasis on management and diagnosis.
Fees, Attestation and Timeline
The initial fee is USD $350 in total: $100 for registration and administration plus $250 for the examination. That excludes the cost of CME, travel to a test center, and any commercial prep. Our certification cost breakdown walks through the full budget.
- Confirm your PA-C status and unrestricted licensure.
- Accumulate the required nephrology practice hours and Category I CME.
- Apply and pay the fees through NCCPA.
- Schedule and sit for the exam at Pearson VUE.
- Complete the attestation, before the exam or within 90 days after score notification.
- Receive your result; scores generally arrive eight to ten weeks after administration, following validation.
Scheduling specifics and deadlines are covered in our exam dates guide.
Keeping the Certificate for Ten Years
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 time of your maintenance-exam application, plus passing the specialty exam. Older summaries citing 150 credits are not supported.
Under the May 2026 governing policy, you may make three maintenance attempts in years nine and ten, and passing earlier can reset the cycle. Maintenance can be taken at a test center or online. The online version keeps 120 questions but allows five minutes per question within an approximately six-week window, and references are permitted while assistance from others is not. Those are maintenance-only conditions; there is no remote option for the initial exam.
Sequencing Your Preparation
One short scheduling idea tied to the blueprint: front-load the heavy domains, then layer in the narrow ones. A workable ordering, which you can stretch or compress to fit your calendar:
Chronic Kidney Disease and Hypertension
- Together they carry 30% of the content weight and connect naturally.
- Practice management-style questions, since management is the largest task category.
End-Stage Renal Disease / Dialysis and Acute Kidney Injury/ICU
- Pair chronic and acute kidney replacement thinking.
- Use your clinical exposure to anchor the material.
Renal Pathophysiology
- Revisit mechanisms so earlier clinical material makes deeper sense.
The smaller domains and a timed run
- Cover Glomerular, Systemic, Tubulointerstitial/Viral, Transplantation, Vascular, and Legal/Ethical topics.
- Rehearse two 60-question blocks without going back.
Use the official resources first: NCCPA's Sample Nephrology Questions & Critiques (copyright 2024) and the optional $50 practice exam, which is one form with a 180-day completion window. NCCPA notes that its feedback is educational and does not predict an exam pass. For a fuller plan, see the PA-CN study guide, and for a condensed review sheet, the PA-CN cheat sheet. You can also rehearse the question style with the practice tests on the main site.
Where the Credential Fits at Work
The attestation settings give a good picture of where this credential lives: practices managing chronic kidney disease, dialysis units, transplant programs, and inpatient dialysis services. PAs in these environments often work alongside nephrologists, so the certificate documents specialty knowledge for colleagues, employers, and credentialing staff.
Be careful with financial expectations. This site does not adopt any CAQ-specific salary or pass-rate figures, and a pay premium caused by the certificate should not be assumed. Compensation varies by employer, region, and experience, and some employers may value the credential for credibility rather than pay. Our salary guide, jobs overview, and worth-it analysis treat these questions qualitatively.
Frequently Asked Questions
It is shorthand for NCCPA's Certificate of Added Qualifications in Nephrology, officially designated PA-C, CAQ-Neph. It is not an entry-level PA certification or a nursing credential.
No. You need 4,000 total PA practice hours, of which at least 2,000 must be in nephrology, within the six years before you attest that the experience requirement is met.
No. Initial testing takes place at Pearson VUE test centers. The online format applies only to maintenance exams, with its own rules on timing and references.
Chronic Kidney Disease is the largest content category at 20%, followed by End-Stage Renal Disease / Dialysis at 17%. Starting there gives the most coverage per hour of study.
Ten years, provided your PA-C and licensure stay current. Renewal needs 125 nephrology Category I CME credits and a passing maintenance exam. Confirm any ninth-year timing questions with NCCPA.