Concepts of Kidney Disease
38%of exam
Hemodialysis
30%of exam
Peritoneal Dialysis
22%of exam
Transplant
5%of exam
EvaluationRejectionImmunosuppressionInfections
Acute Therapies
5%of exam
Quick Facts
- Exam
- CNN
- Credential
- Certified Nephrology Nurse
- Body
- NNCC
- Questions
- 150 MCQ
- Time
- 3 hours
- Pass
- Standard score 95
- Target
- 70% correct
- Fee
- $350 standard
- Eligibility
- RN plus 3000 hours
CKD GFR Ladder
90, 60, 45, 30, 15
G1G2G3aG3bG4G5
Hyperkalemia vs Acidosis
Hyperkalemia
- ECG danger
- Dialysate K
- Urgent treatment
Acidosis
- Low bicarbonate
- Bone muscle effects
- Alkali therapy
Potassium kills fastest
Kidney Picker
- GFR below 30→Plan KRT(Educate early)
- High phosphate→Binders(With meals)
- Low hemoglobin→Check iron(Then ESA)
- High potassium→ECG first(Urgent risk)
- Metabolic acidosis→Bicarbonate therapy(Assess CO2)
- NSAID use→Stop nephrotoxin(Preserve function)
CKD Staging
- G1
- GFR 90+
- G2
- GFR 60-89
- G3a
- GFR 45-59
- G3b
- GFR 30-44
- G4
- GFR 15-29
- G5
- GFR below 15
- A1
- ACR below 30
- A3
- ACR above 300
Kidney Functions
- Glomerulus
- Filters plasma
- Tubule
- Reabsorbs and secretes
- Creatinine
- Filtered plus secreted
- EPO
- RBC signal
- Renin
- RAAS trigger
- Calcitriol
- Active vitamin D
- Uremia
- Toxin syndrome
CKD Complications
- Hyperkalemia
- Arrhythmia risk
- Acidosis
- Low bicarbonate
- Anemia
- Low EPO
- MBD
- Bone-mineral disorder
- Pruritus
- Uremic symptom
- HTN
- Volume/RAAS driven
- Neuropathy
- Uremic complication
Medication Safety
- ACEi/ARB
- Lower proteinuria
- NSAIDs
- Avoid nephrotoxicity
- ESA
- Treats anemia
- Iron
- ESA support
- Binders
- Take with meals
- Calcimimetic
- Lowers PTH
- Dose adjust
- Use GFR
HD Dose Targets
Kt/V 1.2, URR 65
AdequacyBUN dropSamplingRecirculation
AVF vs AVG
AVF
- Native vessels
- Lower infection
- Long maturation
AVG
- Synthetic conduit
- Higher infection
- Faster use
Fistula preferred when feasible
HD Picker
- Absent thrill→Do not cannulate(Notify provider)
- Low Kt/V→Check recirculation(Verify sampling)
- Cramps late run→Assess UF rate(Volume shift)
- Hypotension→Stop UF(Assess volume)
- Fever chills→Culture access(Suspect sepsis)
- Pyrogenic cluster→Check water(Endotoxin risk)
HD Adequacy
- Kt/V
- Dose measure
- spKt/V
- Single-pool dose
- URR
- BUN reduction
- Target Kt/V
- At least 1.2
- Target URR
- At least 65%
- Recirculation
- Lowers clearance
- Post-BUN
- Draw correctly
- Shortened run
- Reduces dose
URR vs Kt/V
URR
- Simple BUN drop
- Percent target
- Ignores UF
Kt/V
- Dose index
- Volume adjusted
- Preferred adequacy
Kt/V is fuller dose
HD Access
- AVF
- Preferred access
- AVG
- Higher infection
- CVC
- Last resort
- Thrill
- Palpable flow
- Bruit
- Audible flow
- Steal
- Distal ischemia
- Aneurysm
- Avoid cannulation
- Right IJ
- Preferred catheter
HD Prescription
- BFR
- Blood flow rate
- DFR
- Dialysate flow rate
- UF
- Fluid removal
- Target weight
- Euvolemic weight
- Sodium
- Volume thirst driver
- Potassium bath
- Controls K removal
- Heparin
- Prevents clotting
Water Safety
- RO
- Primary purification
- Chloramine
- Hemolysis risk
- Endotoxin
- Pyrogenic reaction
- Conductivity
- Electrolyte check
- pH
- Dialysate check
- Aluminum
- Bone neurotoxicity
- Disinfection
- Biofilm control
PD Peritonitis Rule
Cloudy bag means culture now
CloudyPainWBCPMNCulture
CAPD vs APD
CAPD
- Manual exchanges
- Daytime work
- No cycler
APD
- Cycler exchanges
- Night therapy
- Lifestyle fit
Match lifestyle and transport
PD Picker
- Cloudy effluent→Culture fluid(Start IP antibiotics)
- Slow drain→Check constipation(Reposition catheter)
- Poor UF→Increase dextrose(Assess membrane)
- Long dwell→Icodextrin(Sustained UF)
- Exit drainage→Culture site(Treat infection)
- Fungal peritonitis→Remove catheter(Systemic antifungal)
PD Modalities
- CAPD
- Manual exchanges
- APD
- Cycler therapy
- CCPD
- Cycler plus dwell
- NIPD
- Night only
- PET
- Transport test
- Dwell
- Equilibration time
- Icodextrin
- Long dwell UF
Peritonitis vs Exit Infection
Peritonitis
- Cloudy effluent
- Abdominal pain
- Effluent culture
Exit infection
- Drainage redness
- Exit culture
- Track assessment
Culture the right site
PD Complications
- Cloudy effluent
- Peritonitis until proven
- WBC
- Above 100/uL
- PMN
- Above 50%
- Exit infection
- Drainage erythema
- Tunnel infection
- Track tenderness
- Leak
- Reduce fill
- Hernia
- Pressure complication
- Fungal
- Remove catheter
PD Prescription
- Dextrose
- Osmotic UF
- 1.5%
- Low UF
- 2.5%
- Moderate UF
- 4.25%
- High UF
- Fill volume
- Clearance driver
- Exchanges
- Clearance driver
- Weekly Kt/V
- At least 1.7
Transplant Red Flags
Fever, graft pain, urine drop
InfectionRejectionObstructionToxicity
Acute vs Chronic Rejection
Acute
- Days to months
- Rising creatinine
- Often treatable
Chronic
- Months to years
- Progressive fibrosis
- Often irreversible
Timing guides suspicion
Transplant Core
- ABO
- Compatibility screen
- HLA
- Tissue matching
- PRA
- Sensitization measure
- Crossmatch
- Antibody risk
- Tacrolimus
- Monitor trough
- Mycophenolate
- Antimetabolite
- Prednisone
- Steroid suppression
- BK virus
- Reduce immunosuppression
CRRT Mode Key
D dialysate, H hemofiltration
CVVHDCVVHCVVHDFSCUF
Diffusion vs Convection
Diffusion
- Concentration gradient
- Small solutes
- Dialysate driven
Convection
- Solvent drag
- Middle molecules
- UF driven
Mechanism determines modality
Acute Picker
- Unstable ICU→CRRT(Gentle removal)
- Fluid only→SCUF(No solute focus)
- Need convection→CVVH(Replacement fluid)
- Need diffusion→CVVHD(Dialysate flow)
- Need both→CVVHDF(Max clearance)
- Antibody removal→Apheresis(Plasma exchange)
Acute Therapies
- CRRT
- Continuous ICU KRT
- SCUF
- Fluid removal
- CVVH
- Convection clearance
- CVVHD
- Diffusion clearance
- CVVHDF
- Both clearances
- SLED
- Prolonged intermittent
- Citrate
- Regional anticoagulation
- Apheresis
- Plasma component removal
CVVHD vs CVVH
CVVHD
- Uses dialysate
- Diffusive clearance
- Small solutes
CVVH
- Uses replacement
- Convective clearance
- Middle molecules
D equals dialysate
Common Traps
Binder Timing
With first bite ≠ Not after meals
Absent Thrill
Do not cannulate ≠ Notify immediately
Low Adequacy
Verify sampling ≠ Before increasing time
Cloudy PD Fluid
Treat as peritonitis ≠ Do not observe
CVC Fever
Suspect bloodstream infection ≠ Culture before antibiotics
High Calcium Phosphate
Avoid calcium binders ≠ Lower phosphate burden
Tacrolimus Toxicity
Check trough level ≠ Watch creatinine rise
Outpatient HD Eligibility
Need 750 hours ≠ Beyond chronic HD
Last Minute
- 1.Blueprint: 38/30/22/5/5
- 2.150 questions, 3 hours
- 3.Pass = standard score 95
- 4.Eligibility: RN, 3000 hours
- 5.Outpatient HD needs 750 hours
- 6.CKD G5: GFR below 15
- 7.Binders go with meals
- 8.Kt/V target at least 1.2
- 9.URR target at least 65%
- 10.Absent thrill: no cannulation
- 11.Cloudy PD effluent: culture
- 12.CRRT for unstable ICU
Buy on Amazon
Practice exams on ExamEdge
Take courses on Udemy
Flashcards on MometrixSame family resources
Explore More NNCC Nephrology Nursing Certifications
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
More From This Family
Videos and articles for deeper review.