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100+ Free CAQ-Nephrology Practice Questions

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Following thrombolysis of an embolic event, a patient develops AKI, livedo reticularis on the toes, eosinophilia, and low complement. What is the most likely diagnosis?

A
B
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Key Facts: CAQ-Nephrology Exam

120

Total Items

NCCPA CAQ

3 hrs

Exam Time

NCCPA

$350

Exam Fee

NCCPA

3,000 hrs

Practice Required

Prior 6 yrs nephrology-PA

NCCPA CAQ-Nephrology is the PA subspecialty credential for nephrology. 120 items, 3 hours, $350. Eligibility: 3,000 hours nephrology practice + 150 nephrology CME. Master KDIGO CKD staging (G1-G5 + A1-A3), SGLT2/finerenone for diabetic CKD, lupus nephritis induction (MMF/cyclophosphamide), and AVF maturation timelines.

Sample CAQ-Nephrology Practice Questions

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

1A 68-year-old man is hospitalized with sepsis. His baseline serum creatinine is 1.0 mg/dL. Today his creatinine is 1.4 mg/dL, up from 1.0 mg/dL 36 hours ago. Per KDIGO criteria, which stage of AKI does this represent?
A.No AKI
B.Stage 1 AKI
C.Stage 2 AKI
D.Stage 3 AKI
Explanation: KDIGO defines AKI as an increase in serum creatinine of >=0.3 mg/dL within 48 hours, or >=1.5x baseline within 7 days, or urine output <0.5 mL/kg/h for >=6 hours. A 0.4 mg/dL rise in 36 hours meets the >=0.3 mg/dL criterion. Stage 1 = sCr 1.5-1.9x baseline OR >=0.3 mg/dL increase.
2A 75-year-old woman with heart failure presents with oliguria. BUN 60, sCr 2.4 (baseline 1.0), urine sodium 12 mEq/L, FENa 0.6%, urine specific gravity 1.025. Bland sediment. Which etiology is most likely?
A.Pre-renal AKI
B.Acute tubular necrosis
C.Acute interstitial nephritis
D.Post-renal obstruction
Explanation: FENa <1%, urine Na <20 mEq/L, BUN/Cr ratio >20:1, and concentrated urine indicate pre-renal physiology. The kidney is appropriately retaining sodium and water in response to decreased effective circulating volume from heart failure.
3A 60-year-old man develops AKI 48 hours after coronary angiography with 150 mL of iodinated contrast. Which statement about contrast-induced nephropathy (CIN) is most accurate?
A.Peak creatinine occurs at 7-10 days
B.Isotonic IV crystalloid before and after contrast is the most evidence-based prevention
C.N-acetylcysteine reduces hard clinical outcomes per the PRESERVE trial
D.Sodium bicarbonate is superior to normal saline for prevention
Explanation: Isotonic IV fluid (normal saline) administered before and after contrast remains the cornerstone of CIN prevention. The PRESERVE trial (2018) showed neither IV sodium bicarbonate nor oral N-acetylcysteine prevented contrast-associated AKI or improved outcomes compared with saline.
4A patient in the ICU develops anuric AKI with K 6.8, pH 7.15, BUN 110, and pulmonary edema unresponsive to diuretics. Which is the most appropriate next step?
A.Continue medical management for 24 more hours
B.Initiate renal replacement therapy
C.Trial of high-dose loop diuretics
D.Sodium polystyrene sulfonate orally
Explanation: Classic AEIOU indications for urgent dialysis include severe Acidosis, Electrolyte derangement (refractory hyperkalemia), Ingestions, Overload (refractory pulmonary edema), and Uremia. This patient meets multiple criteria, requiring urgent RRT.
5A 70-year-old man with septic shock has hemodynamic instability and AKI requiring RRT. Which RRT modality is most appropriate?
A.Intermittent hemodialysis 4 hours TIW
B.Continuous renal replacement therapy (CRRT)
C.Peritoneal dialysis
D.Sustained low-efficiency dialysis (SLED) only
Explanation: CRRT is preferred for hemodynamically unstable critically ill patients because slow continuous solute and fluid removal causes less hemodynamic compromise than intermittent HD. KDIGO recommends CRRT or SLED over IHD for unstable patients.
6A patient with crush injury from a building collapse has dark brown urine, K 6.5, sCr 3.2, CK 45,000. Urine dipstick is strongly positive for blood but no RBCs on microscopy. Which is the most appropriate management?
A.Aggressive isotonic IV fluids targeting urine output 200-300 mL/h
B.Urgent hemodialysis
C.IV mannitol monotherapy
D.Urinary alkalinization with ammonium chloride
Explanation: Rhabdomyolysis-induced AKI is treated with aggressive isotonic crystalloid resuscitation to maintain urine output 200-300 mL/h, flushing myoglobin from tubules. Heme-positive dipstick without RBCs is classic for myoglobinuria.
7A 55-year-old woman started a new antibiotic 10 days ago and now has sCr 2.5 (baseline 0.9), low-grade fever, maculopapular rash, and 8% peripheral eosinophils. Urinalysis shows WBC casts. Which finding is most specific for the suspected diagnosis?
A.Muddy brown granular casts
B.WBC casts and sterile pyuria
C.Red blood cell casts
D.Hyaline casts
Explanation: This is classic acute interstitial nephritis (AIN), often from beta-lactams, sulfonamides, NSAIDs, or PPIs. WBC casts with sterile pyuria, plus fever-rash-eosinophilia triad, support AIN. Definitive diagnosis is biopsy.
8A 65-year-old man with BPH presents with anuria for 24 hours and bilateral flank pain. sCr 4.5 (baseline 1.1). Which initial test is most appropriate?
A.Renal biopsy
B.Renal ultrasound
C.CT angiography
D.24-hour urine protein
Explanation: Bilateral hydronephrosis on renal ultrasound is the initial test of choice for suspected obstructive (post-renal) AKI. Bladder outlet obstruction from BPH commonly causes this. Foley catheter placement is both diagnostic and therapeutic.
9A patient with cirrhosis has sCr that rose from 0.8 to 2.0 mg/dL despite albumin and diuretic withdrawal. Urine Na 8 mEq/L, no proteinuria, normal renal ultrasound. Which is the most likely diagnosis?
A.Acute tubular necrosis
B.Hepatorenal syndrome (HRS-AKI)
C.Pre-renal azotemia from diuretics
D.Spontaneous bacterial peritonitis-induced AKI
Explanation: HRS-AKI is diagnosed when AKI persists despite diuretic withdrawal and 2 days of albumin volume expansion (1 g/kg/day, max 100 g) in cirrhosis with ascites, no shock, no nephrotoxins, and absence of intrinsic kidney disease. Treatment is terlipressin (now FDA-approved) plus albumin.
10In a patient already on diuretics, which marker is more reliable than FENa for distinguishing pre-renal AKI from ATN?
A.Fractional excretion of urea (FEUrea)
B.Urine specific gravity
C.BUN/creatinine ratio
D.Serum cystatin C
Explanation: FEUrea <35% suggests pre-renal AKI even in patients on loop or thiazide diuretics, because urea reabsorption occurs primarily in the proximal tubule and is less affected by these diuretics than sodium handling.

About the CAQ-Nephrology Exam

NCCPA Certificate of Added Qualifications in Nephrology — for PAs in nephrology practice. Covers AKI workup and management, CKD staging and progression slowing (KDIGO/KDOQI), glomerular disease (lupus nephritis, IgA, MN, FSGS, ANCA), electrolyte and acid-base disorders, hypertension and renovascular disease, dialysis (HD/PD access, prescription, complications), kidney transplantation (induction/maintenance, rejection), and nephrolithiasis/tubular disorders.

Questions

120 scored questions

Time Limit

3 hours

Passing Score

Scaled (NCCPA-set)

Exam Fee

$350 (NCCPA)

CAQ-Nephrology Exam Content Outline

20%

CKD (Chronic Kidney Disease)

KDIGO G1-G5 + A1-A3, slowing progression, SGLT2i, ACEi/ARB, finerenone, anemia, MBD

15%

AKI (Acute Kidney Injury)

KDIGO AKI staging, prerenal vs intrinsic vs postrenal, urine indices, RRT indications (AEIOU)

15%

Glomerular Disease

Lupus nephritis (MMF/cyclo), IgA, MN (PLA2R), FSGS, ANCA vasculitis (RAVE/PEXIVAS)

13%

Electrolyte & Acid-Base

Na/K disorders, anion gap MUDPILES, RTA classification, fluid prescribing

11%

Dialysis (HD/PD/Access)

AVF preferred, maturation 6 weeks, Kt/V targets, peritonitis (Cx + intraperitoneal abx)

10%

Hypertension / Renovascular

Resistant HTN workup, RAS (PSV >180, RAR >3.5), CORAL trial, fibromuscular dysplasia

10%

Transplant Nephrology

Induction (basiliximab/ATG), maintenance (tac/MMF/pred), rejection (cellular vs antibody)

6%

Nephrolithiasis & Tubular

24h urine workup, calcium oxalate vs uric acid vs cystine, ADTKD, tubular disorders

How to Pass the CAQ-Nephrology Exam

What You Need to Know

  • Passing score: Scaled (NCCPA-set)
  • Exam length: 120 questions
  • Time limit: 3 hours
  • Exam fee: $350

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

CAQ-Nephrology Study Tips from Top Performers

1Memorize KDIGO CKD staging (G1-G5 + A1-A3) and risk-stratified referral thresholds
2Know the 4 pillars of diabetic CKD therapy: ACEi/ARB + SGLT2i + finerenone + GLP-1
3Drill RRT/AEIOU dialysis indications (Acidosis, Electrolytes/hyperK, Ingestions, Overload, Uremia)
4Master lupus nephritis induction (MMF or low-dose cyclophosphamide + steroids; voclosporin/belimumab adjuncts)
5Know AVF maturation: 6 weeks; Kt/V ≥1.4 per HD session; CKD-MBD targets (PTH, Ca, P)

Frequently Asked Questions

What are KDIGO CKD stages?

KDIGO 2012/2024 stages CKD by GFR + albuminuria. GFR categories: G1 ≥90, G2 60-89, G3a 45-59, G3b 30-44, G4 15-29, G5 <15 mL/min/1.73m². Albuminuria: A1 <30, A2 30-300, A3 >300 mg/g. Risk colors green/yellow/orange/red guide nephrology referral. eGFR <30 with rapidly declining or A3 → refer.

What is finerenone and when is it used?

Finerenone is a non-steroidal mineralocorticoid receptor antagonist (FIDELIO-DKD, FIGARO-DKD). Reduces CKD progression and CV events in adults with type 2 diabetes + CKD when added to maximally tolerated ACEi/ARB. Less hyperkalemia and gynecomastia than spironolactone. SGLT2i (dapagliflozin DAPA-CKD, empagliflozin EMPA-KIDNEY) is also pillar therapy.

How is lupus nephritis induced?

For class III/IV (proliferative) lupus nephritis: induction with mycophenolate mofetil (MMF, 2-3 g/day) OR cyclophosphamide (low-dose Euro-Lupus IV) plus glucocorticoids. Voclosporin or belimumab may be added. Maintenance: MMF or azathioprine for ≥3 years. Goal: complete or partial renal response. Class V (membranous LN) often uses MMF + ACEi/ARB.

How should I study for CAQ-Nephrology?

Plan 80-120 hours over 10-14 weeks. Work the NCCPA CAQ Nephrology content blueprint, drill weighted-domain practice questions, complete required Category 1 CME, and submit experience requirements (typically ≥3,000 hours specialty practice in the prior 6 years and ≥150 specialty CME) before sitting the exam.