- What PA-CN Actually Refers To
- Who Issues It and What the Credential Looks Like
- Eligibility: The Numbers That Trip People Up
- Exam Format and Test-Day Rules
- What the Exam Covers: Domains and Tasks
- Fees, Scores, and the Six-Year Clock
- Keeping the CAQ: Ten Years and Maintenance Exams
- Sequencing Your Prep Around the Blueprint
- Where the Credential Fits in Nephrology Practice
- Frequently Asked Questions
- PA-CN is a site alias for NCCPA's Certificate of Added Qualifications in Nephrology, designated PA-C, CAQ-Neph.
- The exam has 120 multiple-choice questions in two 60-question blocks, with 60 minutes per block and no revisiting finished blocks.
- You need 4,000 total PA practice hours, with at least 2,000 in nephrology, plus 75 nephrology Category I CME credits.
- Chronic Kidney Disease is the largest content category at 20%, followed by ESRD/Dialysis at 17%.
What PA-CN Actually Refers To
If you have searched for "PA-CN," you have probably noticed that the abbreviation is ambiguous. On this site, it means one thing only: the Certificate of Added Qualifications in Nephrology offered to physician assistants. The official designation after your name is PA-C, CAQ-Neph. "PA-CN" is simply the shorthand used here and in the reference table behind this site.
It helps to be clear about what the credential is not. It is not the initial PA-C certification that every practicing PA earns after graduation. It is not a nephrology nursing credential. It is also not a physician nephrology board examination. It is a specialty add-on that a certified PA can earn to document advanced knowledge in kidney medicine. If you want the plain-language version of the terminology, our explainers on what PA-CN stands for and the meaning of PA-CN cover the naming question from other angles.
Who Issues It and What the Credential Looks Like
The certificate is issued by the National Commission on Certification of Physician Assistants (NCCPA), the same body that administers the PANCE and PANRE-era certification pathway for PAs. Initial testing is delivered at Pearson VUE test centers. The official program page lives within NCCPA's specialty certificates section, and that is the place to confirm anything that changes over time.
Earning the CAQ requires two things together: a passing result on the nephrology specialty exam and completion of the non-exam requirements (practice hours, CME, and a practice attestation). Passing the test alone does not award the certificate. For a broader overview of how the credential is positioned, see our guide to what PA-CN certification is.
Eligibility: The Numbers That Trip People Up
Most questions we hear about this credential involve the eligibility math. The requirements are specific, and one of them is easy to misread. Our dedicated PA-CN requirements guide goes deeper, but here is the core list.
| Requirement | Detail |
|---|---|
| Base certification | Current PA-C status |
| Licensure | Unrestricted U.S. PA licensure (or unrestricted government-agency practice privileges); all held licenses must be unrestricted |
| Practice experience | 4,000 total PA practice hours, including at least 2,000 in nephrology, within six years before attesting the experience requirement is satisfied |
| CME | 75 nephrology-focused Category I credits in the six years before exam application, at least 25 of them in the preceding two years |
| Attestation | Signed by a collaborating physician or lead/senior PA in nephrology who knows your practice |
| ACLS | Recommended, not an additional mandatory course |
The Attestation, Explained
The attestation covers procedural and patient-management knowledge and performance. The signer is typically a collaborating physician or a lead or senior PA who works in nephrology. A physician or PA postgraduate program director may sign for a PA who is enrolled in or has graduated from that program. You may submit it before the exam or within 90 days after score notification.
The form speaks to management within at least one listed nephrology practice setting: end-stage renal disease, chronic kidney disease, kidney transplantation, or acute inpatient dialysis. You do not need to work in every nephrology subspecialty, and there is no separate timed practical assessment.
Exam Format and Test-Day Rules
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, and personal calculators, notes, and books are prohibited.
Block Behavior to Plan Around
The most important structural rule is that questions in a finished block cannot be revisited. That changes how you should pace yourself.
- Treat each 60-minute block as a self-contained exam with roughly one minute per question.
- Within a block you can flag and return, but once you submit the block, those answers are final.
- Use the 15-minute break to reset rather than to second-guess block one.
- Without a calculator, be comfortable estimating anion gaps, corrected sodium, and similar bedside calculations by hand.
Initial testing is at a test center. Remote testing exists only in a limited form for maintenance exams (covered below), not for the first attempt. How difficult candidates find the format is discussed in our piece on how hard the PA-CN exam is.
What the Exam Covers: Domains and Tasks
NCCPA publishes a three-page content blueprint for the nephrology CAQ. It classifies every question two ways: by medical content category and by clinical task. Keep these two lenses separate, because they describe the same 120 questions from different angles.
The Eleven Medical Content Categories
| 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% |
Notice how top-heavy this is. Chronic Kidney Disease, ESRD/Dialysis, and Renal Pathophysiology together account for over half of the exam. Adding Acute Kidney Injury/ICU Nephrology and Hypertension brings you to roughly three-quarters of all questions. The examples the blueprint lists under each heading are illustrative, not exhaustive, so treat them as a floor rather than a ceiling. For a category-by-category walkthrough, read our complete guide to all 11 content areas.
The Six Clinical Tasks
Separately, the blueprint distributes questions across task types:
- 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
The task percentages and the domain percentages are two views of the same exam, so never add them together. A single question might be classified as Chronic Kidney Disease by content and Managing Patients by task. The practical lesson: more than a third of the exam asks what you would do, such as choosing therapy, adjusting medications, or deciding on intervention, rather than what the disease is.
Fees, Scores, and the Six-Year Clock
The initial examination fee is $350 total: $100 for registration and administration plus $250 for the examination itself. That figure comes from NCCPA's published FAQs, and you should verify it before paying since fees can be revised. A fuller breakdown of what else you might spend, such as CME, prep materials, and travel, is in our certification cost guide.
Scores generally arrive eight to ten weeks after administration, following validation. The initial CAQ process must be completed within six years after you initiate it, so there is a hard outer limit on how long you can take to assemble hours, CME, attestation, and a passing result. Scheduling mechanics are covered in our exam dates and scheduling guide.
One thing we deliberately do not claim: a specific numeric passing threshold or an official specialty-specific pass rate. Neither was verified for this exam, and commercial "guaranteed pass" promises should be treated skeptically. Our pages on the passing score and pass rate explain what is and is not publicly known.
Keeping the CAQ: Ten Years and Maintenance Exams
The certificate is valid for ten years, provided your PA-C status and licensure stay current. Renewal requires two components: 125 nephrology Category I CME credits earned during the cycle and submitted by the time of the maintenance-exam application, plus passing the specialty examination.
Maintenance Testing Options
- Test center or online: Maintenance can be taken either way.
- Online format: It keeps 120 questions but allows five minutes per question within an approximately six-week window. References are allowed; assistance from other people is not.
- Attempts: The May 2026 governing policy allows three maintenance attempts in years nine and ten.
The online option is a maintenance-only accommodation. It does not apply to your first exam.
Sequencing Your Prep Around the Blueprint
Generic study advice is plentiful; what matters here is that your calendar mirrors the blueprint's weights. A reasonable sequence, building on our fuller PA-CN study guide, looks like this:
Chronic Kidney Disease and ESRD / Dialysis
- These two categories carry 37% of the content, so front-load them.
- Staging, progression slowing, mineral-bone disorder, anemia, and dialysis modality decisions.
Renal Pathophysiology and Acute Kidney Injury/ICU Nephrology
- Acid-base, electrolytes, and tubular physiology underpin many questions across other categories.
- Prerenal versus intrinsic versus postrenal patterns and renal replacement considerations in critical illness.
Hypertension, Glomerular, Systemic, Tubulointerstitial, Transplant, Vascular
- Smaller individual weights, but together they make up a meaningful share.
- Immunosuppression and post-transplant management reward careful pharmacology review.
Official materials and timed blocks
- Work NCCPA's Sample Nephrology Questions & Critiques.
- Consider the optional $50 NCCPA practice exam, then rehearse two 60-minute blocks without notes or a calculator.
NCCPA lists one practice form for this specialty, with a 180-day completion window. Its feedback is educational and does not predict whether you will pass, so use it to find weak categories rather than to forecast a result. A one-page refresher of high-yield facts is available in our PA-CN cheat sheet, and for realistic timed repetition you can use the main practice test site.
Key Takeaway
Because the Managing Patients task is 35% of the exam, convert every topic you study into a decision: which drug, which dose adjustment, which intervention, which referral. Facts alone will not carry you through a management-heavy exam.
Where the Credential Fits in Nephrology Practice
PAs who sit for this CAQ are typically already working alongside nephrologists. Common settings line up with the attestation's practice categories: outpatient CKD clinics, dialysis units, transplant programs, and inpatient consult services that manage acute dialysis. Employers in those settings include nephrology group practices, hospital systems, dialysis organizations, and transplant centers. We cover the hiring side in more detail in our overview of PA-CN jobs.
Whether the credential changes your pay is a separate question we do not answer with invented numbers. There is no verified CAQ-specific salary figure, and the certificate should not be assumed to cause a pay premium. If you are weighing the investment, our analyses of whether the certification is worth it and the salary picture frame the decision qualitatively.
Frequently Asked Questions
No. PA-C is the initial certification all practicing PAs hold. PA-CN here refers to the nephrology Certificate of Added Qualifications, which requires an active PA-C and is designated PA-C, CAQ-Neph.
No. You need 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 met.
No. Initial testing is at Pearson VUE test centers. An online format exists only for maintenance exams, with its own rules on timing and reference use.
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%.
Ten years, as long as your PA-C and licensure remain current. Renewal requires 125 nephrology Category I CME credits plus passing the specialty maintenance examination.