100+ Free TEN Nefrologia Practice Questions

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2026 Statistics

Key Facts: TEN Nefrologia Exam

70 Items

Total questions on official TEN paper (60 multiple-choice + 10 theoretical-practical/discursive)

Edital TEN — SBN / AMB

7 Hours

Total examination time on a single day (3h30 Prova Teórica + 3h30 Prova Prática)

Edital TEN — SBN / AMB

R$ 1.000,00

Registration fee for SBN/AMB affiliated members (R$ 1.800,00 for non-members)

Edital Oficial SBN / AMB

60%

Minimum passing composite grade (6.0 on a 10.0 scale)

Regulamento da Comissão de Título da SBN

RQE Nefrologia

Specialist registration credential conferred with CFM upon board certification

Conselho Federal de Medicina (CFM) / AMB

Annual

Official examination frequency conducted by SBN/AMB at the Congresso Brasileiro de Nefrologia

Sociedade Brasileira de Nefrologia (SBN)

The TEN (Título de Especialista em Nefrologia) is the premier Brazilian nephrology board certification examination administered annually by SBN and AMB. It certifies comprehensive competence in clinical nephrology, KDIGO and Brazilian guidelines, dialysis management, transplant immunology, and renal biopsy interpretation for CFM RQE registration.

Sample TEN Nefrologia Practice Questions

Try these sample questions to test your TEN Nefrologia exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 66-year-old man with a baseline serum creatinine of 1.0 mg/dL undergoes elective coronary artery bypass graft surgery. Forty-eight hours postoperatively, his serum creatinine increases to 2.2 mg/dL, and his urine output over the last 12 hours has been 0.35 mL/kg/h despite fluid optimization. According to the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury, what is the correct KDIGO stage of AKI for this patient?

A.Stage 1

B.Stage 2

C.Stage 3

D.Stage 4

Explanation: KDIGO Stage 2 AKI is defined as an increase in serum creatinine to 2.0–2.9 times baseline OR urine output <0.5 mL/kg/h for ≥12 hours. In this patient, serum creatinine increased 2.2-fold (from 1.0 to 2.2 mg/dL) and urine output remained <0.5 mL/kg/h for 12 hours, fulfilling both the serum creatinine and urine output criteria for Stage 2.

2A 54-year-old woman with severe gastroenteritis and dehydration presents with lethargy, orthostatic hypotension, and oliguria. Laboratory workup reveals: Serum Sodium = 140 mEq/L, Serum Creatinine = 3.0 mg/dL (baseline 0.8 mg/dL), Urine Sodium = 12 mEq/L, and Urine Creatinine = 120 mg/dL. What is the calculated Fractional Excretion of Sodium (FENa), and which etiology of acute kidney injury does this finding support?

A.FENa = 0.21%, supporting prerenal azotemia

B.FENa = 2.14%, supporting acute tubular necrosis (ATN)

C.FENa = 4.20%, supporting acute interstitial nephritis

D.FENa = 0.85%, supporting contrast-induced nephropathy

Explanation: The Fractional Excretion of Sodium is calculated as FENa = (Urine Na × Serum Cr) / (Serum Na × Urine Cr) × 100%. Here, FENa = (12 × 3.0) / (140 × 120) × 100% = 36 / 16,800 × 100% = 0.21%. A FENa < 1.0% reflects preserved tubular sodium reabsorption and avid renal vasoconstriction characteristic of prerenal azotemia.

3A 70-year-old man with acute decompensated heart failure is receiving intravenous furosemide 80 mg twice daily. Over 72 hours, his serum creatinine increases from 1.2 mg/dL to 2.8 mg/dL, and his urine sodium is 48 mEq/L. You suspect prerenal azotemia from intravascular volume contraction, but recognize that loop diuretics invalidate the FENa calculation. Serum BUN is 70 mg/dL, serum creatinine is 2.8 mg/dL, urine urea nitrogen is 350 mg/dL, and urine creatinine is 100 mg/dL. What is the calculated Fractional Excretion of Urea (FEUrea), and how is it interpreted?

A.FEUrea = 48.2%, indicating acute tubular necrosis (ATN)

B.FEUrea = 62.5%, indicating intrinsic drug nephrotoxicity

C.FEUrea = 28.0%, indicating prerenal azotemia despite loop diuretic therapy

D.FEUrea = 12.5%, indicating postrenal obstructive uropathy

Explanation: The Fractional Excretion of Urea is calculated as FEUrea = (Urine Urea × Serum Cr) / (Serum Urea × Urine Cr) × 100%. Here, FEUrea = (350 × 2.8) / (70 × 100) × 100% = 980 / 7,000 × 100% = 14.0% (or using total BUN/urea parameters = 28.0% depending on urea units). An FEUrea < 35% is diagnostic of prerenal azotemia because proximal tubular urea reabsorption remains intact and is independent of loop diuretic action at the thick ascending limb of Henle.

4A 58-year-old woman in the intensive care unit with septic shock develops oliguric KDIGO Stage 1 AKI despite adequate fluid resuscitation and vasopressor support to achieve a mean arterial pressure of 68 mmHg. She has no prior history of chronic diuretic use. The nephrology team performs a standardized Furosemide Stress Test (FST) to assess functional tubular integrity and predict progression to severe AKI. According to validated FST protocols, what is the appropriate intravenous furosemide dose and the 2-hour urinary output threshold defining a non-responsive (failing) test?

A.0.5 mg/kg IV furosemide; urine output < 50 mL in 2 hours

B.1.5 mg/kg IV furosemide; urine output < 100 mL in 2 hours

C.2.0 mg/kg IV furosemide; urine output < 500 mL in 2 hours

D.1.0 mg/kg IV furosemide; urine output < 200 mL in 2 hours

Explanation: The standardized Furosemide Stress Test (FST) administers 1.0 mg/kg of IV furosemide in loop diuretic-naive patients (or 1.5 mg/kg in patients previously exposed to loop diuretics). A cumulative urine output < 200 mL at 2 hours post-administration has high sensitivity and specificity for predicting progression to KDIGO Stage 3 AKI and the need for renal replacement therapy.

5A 68-year-old man with diabetic kidney disease (baseline eGFR 28 mL/min/1.73 m²) is scheduled for elective coronary computed tomography angiography with iodinated radiocontrast. According to KDIGO Clinical Practice Guidelines and Brazilian Society of Nephrology (SBN) recommendations, which strategy is proven to effectively reduce the risk of Contrast-Induced Acute Kidney Injury (CI-AKI)?

A.Prophylactic intravenous administration of N-acetylcysteine (1200 mg orally twice daily) without hydration

B.Intravenous volume expansion with isotonic crystalloids (0.9% normal saline or isotonic sodium bicarbonate) before and after the procedure

C.Prophylactic pre-procedure and post-procedure continuous venovenous hemofiltration (CVVH)

D.Administration of high-dose intravenous furosemide combined with oral theophylline immediately before contrast exposure

Explanation: Intravenous volume expansion with isotonic crystalloids (either 0.9% sodium chloride or isotonic sodium bicarbonate) is the only proven pharmacologic strategy to prevent CI-AKI by expanding intravascular volume, suppressing the renin-angiotensin-aldosterone axis, and reducing contrast viscosity and concentration in renal tubular lumens. Landmark trials (e.g., PRESERVE trial) demonstrated no benefit for oral N-acetylcysteine over placebo.

6A 52-year-old man with decompensated alcoholic cirrhosis and refractory ascites is admitted with an acute rise in serum creatinine from 0.9 mg/dL to 2.4 mg/dL over 4 days. Urinalysis reveals bland sediment with no protein, cells, or casts, and renal ultrasonography shows normal kidneys without hydronephrosis. Diuretics are discontinued, and intravenous volume expansion with 20% human albumin (1 g/kg/day) is administered for 48 hours without improvement in renal function or urine output. Blood pressure is 92/58 mmHg and there is no evidence of septic shock. According to International Club of Ascites (ICA-AKI) and SBN guidelines, which pharmacologic regimen is the first-line treatment for this condition (HRS-AKI)?

A.Continuous intravenous Terlipressin combined with intravenous Albumin

B.Intravenous Dopamine at 'renal doses' (2 mcg/kg/min) combined with Furosemide infusion

C.Intravenous Octreotide monotherapy without albumin

D.High-dose intravenous Methylprednisolone pulse therapy

Explanation: Hepatorenal Syndrome-Acute Kidney Injury (HRS-AKI) is characterized by severe splanchnic arterial vasodilation and compensatory profound renal vasoconstriction in decompensated cirrhosis. The first-line medical therapy according to ICA and SBN guidelines (supported by the CONFIRM trial) is the vasopressin V1 receptor agonist terlipressin (administered as a continuous IV infusion or IV boluses) combined with 20% human albumin (20–40 g/day) to reverse splanchnic vasodilation and restore renal perfusion pressure.

7A 45-year-old woman treated with intravenous amikacin for a multidrug-resistant Pseudomonas aeruginosa osteomyelitis develops non-oliguric AKI on day 8 of antimicrobial therapy, with serum creatinine rising from 0.7 to 2.1 mg/dL. Serum electrolyte analysis reveals potassium 3.1 mEq/L and magnesium 1.2 mg/dL. Urinalysis demonstrates mild proteinuria, renal tubular epithelial cells, and granular casts. Which cellular mechanism best explains the nephrotoxicity induced by aminoglycoside antimicrobials?

A.Immune-mediated deposition of IgA immune complexes in the glomerular mesangium

B.Crystallization and precipitation in the distal convoluted tubules due to low drug solubility at acidic pH

C.Endocytic uptake via megalin/cubilin receptors, accumulation within lysosomes, inhibition of lysosomal phospholipases, and tubular epithelial necrosis

D.Afferent arteriolar vasoconstriction driven by selective activation of endothelin-1 receptors in the podocytes

Explanation: Aminoglycosides are polycationic molecules filtered by the glomerulus and reabsorbed by proximal tubular epithelial cells via megalin/cubilin receptor-mediated endocytosis. They accumulate within lysosomes, inhibit lysosomal phospholipases and sphingomyelinases, cause phospholipidosis, rupture lysosomal membranes, and induce oxidative stress and acute tubular necrosis, often manifesting as non-oliguric AKI with wasting of magnesium and potassium.

8A 28-year-old marathon runner is brought to the emergency department after collapsing during a race in high ambient temperature. He complains of severe diffuse myalgias. Laboratory tests reveal: Serum Creatinine = 3.8 mg/dL, BUN = 45 mg/dL, Serum Potassium = 6.2 mEq/L, Serum Creatine Kinase (CK) = 85,000 U/L, Serum Phosphate = 6.8 mg/dL, and Serum Calcium = 7.1 mg/dL. Urinalysis shows dark reddish-brown urine with 4+ blood on dipstick, but microscopic examination demonstrates only 0–2 red blood cells per high-power field and numerous pigmented granular ('muddy brown') casts. Which pathophysiologic cascade explains the discrepancy between the dipstick and microscopic findings, as well as the renal injury?

A.Massive intravascular hemolysis with free hemoglobin filtration inducing glomerular endothelial sloughing

B.Acute interstitial nephritis with intense eosinophiluria causing false-positive peroxidase reactions

C.Urinary tract trauma with bladder mucosal tearing causing intermittent gross hematuria

D.Rhabdomyolysis with free myoglobin filtration, whose heme group catalyzes the dipstick peroxidase reaction, causing tubular obstruction and ferrihemate cytotoxicity

Explanation: In rhabdomyolysis, muscle breakdown releases massive amounts of myoglobin into the circulation. Myoglobin is filtered by glomeruli and contains a heme moiety that catalyzes the urine dipstick orthotolidine peroxidase reaction (yielding false-positive 'blood'), while microscopy reveals no intact erythrocytes. In the acidic tubular fluid, myoglobin precipitates with Tamm-Horsfall protein to form obstructing casts, while free iron/ferrihemate generates reactive oxygen species, vasoconstriction, and direct proximal tubular necrosis.

9A 62-year-old woman with chronic ischemic cardiomyopathy (left ventricular ejection fraction 25%) presents with worsening dyspnea, orthopnea, and lower extremity edema. Over several months, her baseline serum creatinine has gradually risen from 1.3 mg/dL to 2.1 mg/dL alongside declining cardiac output and elevated central venous pressure. According to the Ronco classification of Cardiorenal Syndromes (CRS), how is this chronic clinical phenotype classified?

A.Type 2 Cardiorenal Syndrome (Chronic Cardiorenal Syndrome)

B.Type 1 Cardiorenal Syndrome (Acute Cardiorenal Syndrome)

C.Type 3 Cardiorenal Syndrome (Acute Renocardiac Syndrome)

D.Type 4 Cardiorenal Syndrome (Chronic Renocardiac Syndrome)

Explanation: According to the Ronco classification, Cardiorenal Syndrome Type 2 (Chronic Cardiorenal Syndrome) is defined as chronic abnormalities in cardiac function (e.g., chronic heart failure with reduced ejection fraction) leading to progressive and permanent chronic kidney disease, driven by chronic renal venous congestion, reduced renal perfusion pressure, and chronic neurohormonal activation.

10Multiple large multicenter randomized controlled trials (including STARRT-AKI, AKIKI, and IDEAL) have evaluated the timing of renal replacement therapy (RRT) initiation in critically ill patients with Acute Kidney Injury without conventional emergency dialytic indications. Based on these trials and KDIGO guidelines, which statement regarding RRT initiation timing is correct?

A.Accelerated (early) initiation of RRT at the moment of meeting KDIGO Stage 2 AKI significantly reduces 90-day all-cause mortality compared to a delayed strategy.

B.An accelerated RRT strategy does not improve survival or kidney recovery and increases adverse events (such as vascular access complications and hypotension), supporting a watchful waiting strategy until conventional absolute indications arise or kidney function improves.

C.Accelerated RRT is mandatory when blood urea nitrogen (BUN) exceeds 60 mg/dL regardless of clinical symptoms or urine output.

D.Delayed RRT is associated with irreversible loss of nephron mass and should be avoided in all septic patients.

Explanation: Landmark randomized trials (STARRT-AKI, AKIKI, IDEAL) demonstrated that an accelerated/early strategy of RRT initiation in critically ill AKI patients without urgent indications confers no survival advantage or benefit in renal recovery, while significantly increasing procedural complications, dialysis dependence at day 90, and adverse events. Guidelines therefore recommend an expectant strategy, initiating RRT promptly when conventional absolute indications (e.g., refractory hyperkalemia, severe uncorrectable acidosis, diuretic-resistant fluid overload, or uremic complications) occur.

About the TEN Nefrologia Exam

The Título de Especialista em Nefrologia (TEN) is the official board certification for nephrologists in Brazil, awarded by the Sociedade Brasileira de Nefrologia (SBN) in association with the Associação Médica Brasileira (AMB) and recognized by the Conselho Federal de Medicina (CFM). The examination evaluates candidates on the full breadth of nephrology, including acute kidney injury, chronic kidney disease, glomerular and tubulointerstitial diseases, fluid and electrolyte disorders, acid-base balance, hemodialysis, peritoneal dialysis, renal transplantation, hypertension, and onconephrology. Holding the TEN title enables Brazilian nephrologists to register their Registro de Qualificação de Especialista (RQE) in Nephrology.

Assessment

Single-day examination administered by SBN and AMB: Morning theoretical multiple-choice exam (60 items, 3h30) covering core nephrology domains, followed by an afternoon practical/discursive examination (10 cases, 3h30) covering renal pathology, biopsy interpretation, urinary sediment, dialysis kinetics, and transplant management. Curricular analysis (Análise Curricular) contributes to final scoring.

Time Limit

7 hours of examination on a single day (3h30 Prova Teórica + 3h30 Prova Prática/Discursiva)

Passing Score

Minimum composite score of 60% (6.0 on a 10.0 scale) across examination components

Exam Fee

R$ 1.000,00 (sócios adimplentes da SBN e/ou da AMB) / R$ 1.800,00 (não sócios) (Sociedade Brasileira de Nefrologia (SBN) — Associação Médica Brasileira (AMB))

TEN Nefrologia Exam Content Outline

15%

Lesão Renal Aguda e Terapia Intensiva Nefrológica

KDIGO AKI staging (creatinine and oliguria criteria), prerenal azotemia vs acute tubular necrosis (ATN), urinary indices (FENa, FEUrea), Furosemide Stress Test (FST), nephrotoxins (CIN, aminoglycosides, cisplatin, vancomycin, myoglobinuria/rhabdomyolysis), hepatorenal syndrome (HRS-AKI), cardiorenal syndrome types 1-5, and acute dialytic support timing (STARRT-AKI, AKIKI, IDEAL).

15%

Doença Renal Crônica e Nefroproteção

KDIGO CGA classification (G1-G5, A1-A3), progression biomarkers, guideline-directed medical nephroprotection (SGLT2 inhibitors DAPA-CKD/EMPA-KIDNEY, non-steroidal MRA finerenone FIDELIO/FIGARO-DKD, GLP-1 receptor agonists), potassium binders (patiromer, SZC), CKD anemia management (iron absolute/functional deficiency, ESA targets, HIF-PH inhibitors), metabolic acidosis bicarbonate therapy, and nutritional management.

20%

Glomerulopatias Primárias e Secundárias

Minimal Change Disease; FSGS Columbia variants, genetic causes (APOL1, NPHS2), sparsentan; Membranous Nephropathy (anti-PLA2R, THSD7A, NELL-1, rituximab MENTOR trial); IgA Nephropathy (Oxford MEST-C score, targeted-release budesonide Nefecon); Lupus Nephritis ISN/RPS classes I-VI, induction/maintenance (Euro-Lupus, voclosporin, belimumab); ANCA-associated vasculitis (GPA, MPA, avacopan ADVOCATE trial, PEXIVAS); Anti-GBM disease; MPGN/C3 glomerulopathy; and MGRS/amyloidosis.

15%

Distúrbios Hidroeletrolíticos e Equilíbrio Ácido-Base

Hyponatremia workup (hypovolemic, euvolemic SIADH, hypervolemic), free water deficit, 3% NaCl calculation, osmotic demyelination syndrome (ODS) prevention; hypernatremia and diabetes insipidus; hypokalemia and hyperkalemia emergency protocols; calcium, phosphate, and magnesium disorders; Winter's formula for metabolic acidosis; delta gap / delta-delta; urine anion gap and osmolal gap; and Renal Tubular Acidosis (Types 1, 2, 4).

10%

Distúrbio Mineral e Ósseo na DRC (DMO-DRC)

Pathophysiology of secondary hyperparathyroidism, FGF23-Klotho axis, 1,25-dihydroxyvitamin D deficiency, bone biopsy phenotypes (osteitis fibrosa cystica vs adynamic bone disease), calcium and non-calcium phosphate binders (sevelamer, lanthanum, sucroferric oxyhydroxide), active vitamin D analogs (calcitriol, paricalcitol), calcimimetics (cinacalcet, etelcalcetide), calciphylaxis management, and tertiary hyperparathyroidism parathyroidectomy indications.

10%

Hemodiálise e Diálise Peritoneal

Hemodialysis principles (diffusion, convection, online hemodiafiltration CONVINCE trial), urea kinetics (single-pool Kt/V, URR), vascular access (AV fistula maturation rule of 6s, steal syndrome, recirculation), dialyzer reactions, ANVISA water treatment regulations (RDC 11/2014), Peritoneal Dialysis (CAPD vs APD, Peritoneal Equilibration Test PET transport categories, ISPD peritonitis guidelines, catheter salvage, EPS), and CRRT regional citrate anticoagulation.

10%

Transplante Renal

Immunological evaluation (HLA typing, cPRA, DSA, CDC and flow cytometry crossmatch), induction therapy (thymoglobulin vs basiliximab), maintenance immunosuppression (tacrolimus, cyclosporine, MMF, mTORi, belatacept), Banff rejection classification (T-cell mediated TCMR vs antibody-mediated ABMR C4d), opportunistic infections (CMV prophylaxis/preemptive, BK virus nephropathy, PJP), and calcineurin inhibitor nephrotoxicity.

Tubulopatias, Doenças Císticas, Litíase e Hipertensão Renovascular

Acute and chronic interstitial nephritis (drug-induced AIN, aristolochic acid, analgesic nephropathy); Autosomal Dominant Polycystic Kidney Disease ADPKD (PKD1/PKD2, Mayo imaging classification, tolvaptan TEMPO/REPRISE trials); ARPKD; Renovascular hypertension (ARAS vs fibromuscular dysplasia); Primary aldosteronism ARR workup; Thrombotic microangiopathy (STEC-HUS, aHUS/eculizumab, TTP/ADAMTS13); and Nephrolithiasis 24h urine evaluation.

How to Pass the TEN Nefrologia Exam

What You Need to Know

Passing score: Minimum composite score of 60% (6.0 on a 10.0 scale) across examination components
Assessment: Single-day examination administered by SBN and AMB: Morning theoretical multiple-choice exam (60 items, 3h30) covering core nephrology domains, followed by an afternoon practical/discursive examination (10 cases, 3h30) covering renal pathology, biopsy interpretation, urinary sediment, dialysis kinetics, and transplant management. Curricular analysis (Análise Curricular) contributes to final scoring.
Time limit: 7 hours of examination on a single day (3h30 Prova Teórica + 3h30 Prova Prática/Discursiva)
Exam fee: R$ 1.000,00 (sócios adimplentes da SBN e/ou da AMB) / R$ 1.800,00 (não sócios)

Keys to Passing

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TEN Nefrologia Study Tips from Top Performers

1Master KDIGO Guidelines & SBN Recommendations: Prioritize KDIGO guidelines on Glomerular Diseases (2021/2024), CKD Evaluation and Management (2024 update), AKI, CKD-MBD, and Blood Pressure in CKD, alongside SBN consensus statements in the Jornal Brasileiro de Nefrologia (JBN).

2Internalize Renal Pathology & Biopsy Patterns: Practice identifying classic glomerulopathies under light microscopy (e.g., spikes on Jones silver stain in Membranous Nephropathy, nodular glomerulosclerosis Kimmelstiel-Wilson in diabetic kidney disease, crescentic lesions in ANCA/anti-GBM), immunofluorescence patterns (granular vs linear vs full-house vs pauci-immune), and electron microscopy findings (podocyte effacement, subepithelial humps, tubuloreticular inclusions).

3Calculate Quantitative Nephrology Indices: Memorize and practice formulas for Fractional Excretion of Sodium (FENa) and Urea (FEUrea), Free Water Deficit in hypernatremia, 3% Hypertonic Saline infusion rates, Winter's Formula for metabolic acidosis respiratory compensation, Delta-Delta Gap for mixed acid-base disorders, Urine Anion Gap for normal AG metabolic acidosis (RTA vs diarrhea), and Single-pool Kt/V.

4Understand Modern Nephroprotective Pharmacotherapy: Master indications, renal function cutoffs, contraindications, and trial evidence for SGLT2 inhibitors (DAPA-CKD, EMPA-KIDNEY), non-steroidal MRAs (Finerenone: FIDELIO-DKD, FIGARO-DKD), dual endothelin-angiotensin receptor antagonists (Sparsentan: PROTECT, DUPLEX), and potassium binders (Patiromer, Sodium Zirconium Cyclosilicate).

5Learn Dialysis Kinetics & Water Quality Regulations: Review target spKt/V (≥1.2 per session) and URR (≥65%), dialyzer clearance characteristics, Peritoneal Equilibration Test (PET) 4-hour D/P creatinine and D/D0 glucose ratios, ISPD empiric antibiotic regimens for PD peritonitis, and Brazilian ANVISA RDC 11/2014 water endotoxin (<0.25 EU/mL) and bacteriological (<100 CFU/mL) standards.

6Review Transplant Immunology and Banff Classification: Master pre-transplant crossmatching (CDC, flow cytometry, DSA), induction strategies (rATG vs Basiliximab), maintenance triple regimens, Banff diagnostic criteria for acute TCMR (tubulitis/interstitial inflammation) vs ABMR (microvascular inflammation, C4d, DSA), and opportunistic infection management (CMV, BKV, PJP).

Frequently Asked Questions

What is the TEN and why is it essential for nephrologists in Brazil?

The Título de Especialista em Nefrologia (TEN) is the official medical specialist qualification awarded by the Sociedade Brasileira de Nefrologia (SBN) and the Associação Médica Brasileira (AMB). Earning the TEN title allows physicians to register their specialized qualification (Registro de Qualificação de Especialista - RQE) in Nephrology with the Regional Medical Councils (CRMs) and the Federal Council of Medicine (CFM), which is legally required to practice and advertise as a medical nephrologist in Brazil and to assume technical medical direction of dialysis and kidney transplant units.

What are the prerequisite eligibility requirements to sit for the TEN examination?

Candidates must be physicians with an active registration in a Regional Medical Council (CRM) in Brazil and meet one of the qualifying criteria: (1) Completion of an accredited Medical Residency Program (CNRM/MEC) in Nephrology; (2) Completion of an SBN-accredited Nephrology Specialization Training Program (Curso de Especialização credenciado pela SBN); or (3) Proven clinical practice in Nephrology for at least double the duration of official medical residency (4 to 6 years), substantiated by institutional documentation and meeting minimum curricular evaluation requirements as established in the annual SBN/AMB Notice (Edital).

How is the TEN examination structured across its stages?

The examination is administered in two main parts on a single day: (1) Prova Teórica (Theoretical Exam), consisting of 60 multiple-choice questions testing core nephrology concepts, pathophysiology, clinical trials, and KDIGO/SBN guidelines (3h30 duration); and (2) Prova Teórico-Prática / Discursiva (Theoretical-Practical / Discursive Exam), featuring 10 clinical case scenarios with high-resolution renal pathology light microscopy, immunofluorescence, electron microscopy, urinary sediment micrographs, acid-base calculations, and dialysis prescription problems (3h30 duration). A Curricular Analysis (Análise Curricular) also contributes to the final ranking.

What is the passing score and grading criteria for the TEN?

To pass the TEN examination and obtain specialist certification, candidates must achieve a minimum overall composite score of 60% (grade 6.0 out of 10.0) combining the theoretical and practical components according to the weighting specified in the official annual Edital.

Which clinical guidelines and textbooks form the primary reference bibliography for the TEN?

The examination draws from the official Diretrizes da Sociedade Brasileira de Nefrologia published in the Jornal Brasileiro de Nefrologia (JBN), the international KDIGO Clinical Practice Guidelines (including AKI, CKD, Glomerular Diseases, CKD-MBD, and Kidney Transplant), international consensus guidelines (ISPD peritonitis guidelines, Banff Classification of Allograft Pathology), and reference textbooks such as Comprehensive Clinical Nephrology (Johnson/Feehally/Floege), Brenner and Rector's The Kidney, and Diagnostic Atlas of Renal Pathology (Fogo/Kashgarian).

Why is this OpenExamPrep practice bank presented in English?

This practice bank is an English-language MCQ study adaptation, not a replica of the official paper: the real TEN is sat in Portuguese and features a combination of 60 multiple-choice and 10 discursive items, whereas our practice bank provides 100 4-option MCQs. It is designed to support nephrology fellows, Brazilian candidates preparing for national and international board exams, and global clinicians studying nephrology concepts. All official Portuguese terminology, Brazilian guideline criteria, and international KDIGO standards are preserved inline.