100+ Free Cert Nephrology(SA) Phys Practice Questions

Prepare for the Sub-specialty Certificate in Nephrology of the College of Physicians of South Africa exam with instant access — no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

100+ Questions

100% Free

Loading practice questions...

Same family resources

Explore More CMSA Sub-specialty Certificate Examinations (South Africa)

Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.

CMSA Sub-specialty Certificate in Allergology Cert Allerg(SA) Phys — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Cardiology Cert Cardiology(SA) Paed — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Cardiology Cert Cardiology(SA) Phys — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Clinical Haematology Cert Clin Haematology(SA) Paed — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Clinical Haematology Cert Clin Haematology(SA) Path — South Africa

Practice Questions100 questions

CMSA Sub-specialty Certificate in Clinical Haematology Cert Clin Haematology(SA) Phys — South Africa

Practice Questions100 questions

2026 Statistics

Key Facts: Cert Nephrology(SA) Phys Exam

2 components

Written + oral/OSCE

CMSA Cert Nephrology Regulations

50% each

Subminimum per component

CMSA Examination Regulations

R24 650

Exam Fee

CMSA 2026 Fee Schedule

50% overall

Pass Mark

CMSA Examination Regulations

CMSA

Exam Body

College of Physicians of SA

The Cert Nephrology(SA) Phys is a rigorous two-component exit examination (written short-answer papers plus an oral/OSCE/clinical component, each 50%) for specialist physicians completing sub-specialty nephrology fellowship training in South Africa.

Sample Cert Nephrology(SA) Phys Practice Questions

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

1According to the KDIGO clinical practice guidelines for Acute Kidney Injury (AKI), which of the following criteria defines Stage 1 AKI based on serum creatinine criteria?

A.Increase in serum creatinine to 3.0 times baseline or serum creatinine ≥353.6 µmol/L

B.Increase in serum creatinine by ≥26.5 µmol/L within 48 hours or 1.5–1.9 times baseline within 7 days

C.Increase in serum creatinine to 2.0–2.9 times baseline within 7 days

D.Initiation of renal replacement therapy regardless of serum creatinine level

Explanation: KDIGO Stage 1 AKI is defined as an absolute increase in serum creatinine by ≥26.5 µmol/L within 48 hours, or a relative increase in serum creatinine to 1.5 to 1.9 times baseline within 7 days, or urine output <0.5 mL/kg/h for 6–12 hours.

2A 68-year-old male with chronic heart failure on daily furosemide presents with acute oliguria and an elevated serum creatinine of 210 µmol/L. Which diagnostic parameter is most reliable to distinguish prerenal azotemia from intrinsic acute tubular necrosis (ATN) in this patient?

A.Urine specific gravity > 1.020

B.Fractional excretion of sodium (FENa) < 1%

C.Fractional excretion of urea (FEUrea) < 35%

D.Urine sodium concentration < 20 mmol/L

Explanation: In patients actively receiving loop diuretics, sodium reabsorption in the thick ascending limb is inhibited, rendering FENa and urine sodium falsely elevated (>1% and >20 mmol/L) even in true prerenal states. Fractional excretion of urea (FEUrea) is independent of loop diuretic action because urea reabsorption occurs primarily in the proximal tubule and inner medullary collecting duct. An FEUrea <35% strongly indicates prerenal azotemia.

3Which portion of the nephron is predominantly damaged by aminoglycosides (e.g., gentamicin), leading to non-oliguric acute tubular necrosis?

A.Distal convoluted tubule

B.Cortical collecting duct principal cells

C.Proximal convoluted tubule epithelial cells (S1 and S2 segments)

D.Thick ascending limb of the loop of Henle

Explanation: Aminoglycosides are freely filtered at the glomerulus and endocytosed by megalin-cubilin receptor complexes on the brush border of proximal convoluted tubule (S1/S2) epithelial cells. They accumulate within lysosomes, causing lysosomal rupture, mitochondrial toxicity, phospholipidosis, and cell necrosis leading to non-oliguric ATN.

4A 62-year-old diabetic female with CKD Stage 3b (eGFR 38 mL/min/1.73m²) is scheduled for elective coronary angiography. According to clinical practice guidelines, which intervention is proven to reduce the risk of Contrast-Associated Acute Kidney Injury (CA-AKI)?

A.Intravenous N-acetylcysteine bolus combined with oral sodium bicarbonate

B.Prophylactic intravenous 0.9% isotonic saline expanded volume expansion

C.Prophylactic low-dose dopamine infusion

D.Prophylactic fenoldopam continuous infusion

Explanation: Intravenous volume expansion with isotonic crystalloids (0.9% sodium chloride or sodium bicarbonate) at 1–1.5 mL/kg/h for 12 hours before and after the procedure is the single proven evidence-based measure to prevent CA-AKI in high-risk patients. Large randomized trials (PRESERVE trial) demonstrated no benefit for N-acetylcysteine, dopamine, or fenoldopam.

5A 54-year-old male develops a rise in serum creatinine from 90 to 280 µmol/L three weeks after starting omeprazole for gastro-esophageal reflux disease. Urinalysis reveals sterile pyuria and white blood cell casts. What is the most definitive diagnostic test to establish the diagnosis?

A.Gallium-67 renal scintigraphy scan showing diffuse uptake

B.Urinary eosinophil testing using Hansel stain

C.Serum IgE elevation and peripheral blood eosinophilia count

D.Percutaneous renal biopsy showing tubulointestinal inflammatory infiltrate with eosinophils

Explanation: Renal biopsy is the definitive diagnostic gold standard for drug-induced acute interstitial nephritis (AIN). Biopsy demonstrates patchy interstitial edema, inflammatory infiltrate (T-lymphocytes, macrophages, eosinophils, and plasma cells), and tubulitis. Urinary eosinophil testing lacks both sensitivity and specificity for drug-induced AIN.

6A 28-year-old cross-fit athlete presents with severe muscular pain, dark brownish urine, and serum creatine kinase (CK) of 68,000 U/L. Urine dipstick is strongly positive for 'blood', but microscopy reveals only 0–2 red blood cells per high-power field. Which mechanism accounts for AKI in this setting?

A.Renal vein thrombosis due to hypercoagulability

B.Immune complex deposition within glomerular capillary loops

C.Intratubular obstruction by myoglobin casts, direct tubular toxicity, and intrarenal vasoconstriction

D.Direct immunologic complement-mediated lysis of podocytes

Explanation: Rhabdomyolysis causes AKI (pigment nephropathy) via three synergistic mechanisms: 1) filtered free myoglobin precipitates with Tamm-Horsfall protein in acidic tubular fluid causing distal cast obstruction; 2) ferrihemate generation exerts direct toxic oxidative cytotoxicity on proximal tubular cells; and 3) severe fluid sequestration into damaged muscle triggers volume depletion and renal vasoconstriction.

7Which of the following is a mandatory diagnostic criteria for Hepatorenal Syndrome - Acute Kidney Injury (HRS-AKI) according to the International Club of Ascites (ICA) consensus criteria?

A.Absence of response after 2 consecutive days of withdrawal of diuretics and volume expansion with albumin (1 g/kg/day)

B.Fractional excretion of sodium > 2.0%

C.Presence of proteinuria > 1.0 g/day on 24-hour urine collection

D.Renal ultrasonography demonstrating bilateral small shrunken kidneys

Explanation: The revised ICA criteria for HRS-AKI require: diagnosis of cirrhosis with ascites; diagnosis of AKI according to KDIGO criteria; no response after at least 48 hours of diuretic withdrawal and volume expansion with albumin (1 g/kg/day up to a max of 100 g/day); absence of shock; no current or recent exposure to nephrotoxic drugs; and absence of organic kidney disease (proteinuria <500 mg/day, microhematuria <50 RBC/hpf, normal renal ultrasound).

8A 42-year-old trauma patient in the ICU following emergency laparotomy develops progressive oliguria. Intra-abdominal pressure (IAP) measured via bladder catheter is 24 mmHg, and mean arterial pressure (MAP) is 70 mmHg. What is the calculated Renal Perfusion Pressure (RPP) in this patient?

A.46 mmHg

B.94 mmHg

C.24 mmHg

D.70 mmHg

Explanation: Abdominal Perfusion Pressure (APP) / Renal Perfusion Pressure (RPP) in the presence of intra-abdominal hypertension is calculated as: RPP = Mean Arterial Pressure (MAP) - Intra-Abdominal Pressure (IAP). Here, RPP = 70 mmHg - 24 mmHg = 46 mmHg. An RPP < 60 mmHg severely compromises renal blood flow and glomerular filtration.

9A 32-year-old male presents with sudden onset generalized edema, serum albumin of 18 g/L, 24-hour urinary protein of 8.4 g, and normal kidney function. Light microscopy of renal biopsy shows normal glomeruli, and immunofluorescence is completely negative. What expected ultrastructural finding on electron microscopy confirms the diagnosis?

A.Widespread thinning and splitting of the glomerular basement membrane

B.Diffuse effacement of podocyte foot processes

C.Subepithelial immune complex electron-dense spikes

D.Subendothelial electron-dense deposits with double-contour duplication

Explanation: This patient presents with classic Minimal Change Disease (MCD). Light microscopy appears normal (hence 'minimal change') and immunofluorescence is negative. Electron microscopy (EM) characteristically reveals diffuse effacement (flattening/fusion) of visceral epithelial cell (podocyte) foot processes.

10Which target antigen is responsible for approximately 70–80% of primary (idiopathic) Membranous Nephropathy cases?

A.M-type phospholipase A2 receptor (PLA2R)

B.Neural epidermal growth factor-like 1 (NELL-1)

C.Thrombospondin type-1 domain-containing 7A (THSD7A)

D.Semaphorin 3B (SEMA3B)

Explanation: Transmembrane glycoprotein M-type phospholipase A2 receptor (PLA2R), expressed on human podocytes, is the major target autoantigen in 70–80% of primary membranous nephropathy cases. Circulating anti-PLA2R antibodies correlate with disease activity, histologic severity, and therapeutic response.

About the Cert Nephrology(SA) Phys Exam

The Sub-specialty Certificate in Nephrology [Cert Nephrology(SA) Phys] is the specialist sub-specialty qualification administered by the College of Physicians of South Africa. It validates expert consultant-level competency across adult clinical nephrology, renal pathology, critical care nephrology, hemodialysis, peritoneal dialysis, renal transplantation, hypertension, and fluid/electrolyte/acid-base disorders.

Assessment

Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 4 equal domain areas: Acute Kidney Injury & Critical Care Nephrology (25%), Glomerulonephritis & Systemic Diseases with Renal Involvement (25%), Chronic Kidney Disease & Dialysis (Hemodialysis/Peritoneal) (25%), Renal Transplantation, Hypertension & Electrolyte Disorders (25%).

Time Limit

Written short-answer papers plus an OSCE and viva component.

Passing Score

Overall pass mark 50% with a 50% subminimum in each of the two components (written and oral/OSCE/OSPE/clinical).

Exam Fee

R24 650 (College of Physicians of South Africa (Colleges of Medicine of South Africa))

Cert Nephrology(SA) Phys Exam Content Outline

25%

Acute Kidney Injury & Critical Care Nephrology

Pathophysiology and KDIGO criteria of AKI, toxic and ischemic tubular necrosis, interstitial nephritis, pigment nephropathies, hepatorenal syndrome, CRRT modalities, regional citrate anticoagulation, and ICU fluid dynamics.

25%

Glomerulonephritis & Systemic Diseases with Renal Involvement

Primary glomerulonephritides (IgAN, Membranous, MCD, FSGS, C3 glomerulopathy), ANCA vasculitis, Lupus Nephritis (ISN/RPS classes), anti-GBM disease, amyloidosis, thrombotic microangiopathies, and SA-endemic infections (HIVAN, HIVICK, TB, Malaria).

25%

Chronic Kidney Disease & Dialysis (Hemodialysis/Peritoneal)

CKD staging, SGLT2i and finerenone disease-modifying therapy, CKD-MBD management, anemia protocols (ESAs, HIF-PHIs), hemodialysis access/adequacy/water purity, and peritoneal dialysis modalities, PET testing, and ISPD peritonitis protocols.

25%

Renal Transplantation, Hypertension & Electrolyte Disorders

Immunosuppression induction and maintenance, rejection phenotypes (TCMR, ABMR), opportunistic infections (BK, CMV), secondary and resistant hypertension, and complex dysnatremias, dyskalemias, and acid-base disturbances (RTA types 1-4).

How to Pass the Cert Nephrology(SA) Phys Exam

What You Need to Know

Passing score: Overall pass mark 50% with a 50% subminimum in each of the two components (written and oral/OSCE/OSPE/clinical).
Assessment: Two components each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Content spans 4 equal domain areas: Acute Kidney Injury & Critical Care Nephrology (25%), Glomerulonephritis & Systemic Diseases with Renal Involvement (25%), Chronic Kidney Disease & Dialysis (Hemodialysis/Peritoneal) (25%), Renal Transplantation, Hypertension & Electrolyte Disorders (25%).
Time limit: Written short-answer papers plus an OSCE and viva component.
Exam fee: R24 650

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Cert Nephrology(SA) Phys Study Tips from Top Performers

1Focus on KDIGO clinical practice guidelines for AKI, CKD, Glomerulonephritis, and Transplant Candidate/Recipient evaluation, as well as ISPD guidelines for Peritoneal Dialysis.

2Master acid-base calculations (Winter's formula, delta-delta ratio, serum/urine anion gaps, urine osmolal gap) and renal replacement kinetics (Kt/V, sieve coefficients, citrate clearance).

3Understand regional South African nephrology challenges, including HIV-associated nephropathies (HIVAN, HIVICK), TB interstitial nephritis, herbal toxin-induced nephropathies, and equitable resource allocation in renal replacement therapy.

Frequently Asked Questions

What is the format of the CMSA Cert Nephrology(SA) Phys examination?

The exit examination has two components, each contributing 50%: a written component (short-answer written papers) and an oral/OSCE/OSPE/clinical component. Candidates must achieve an overall 50% with a 50% subminimum in each component. This free question bank provides 100 practice MCQs as a study aid and does not replicate the official format.

What is the fee for the Cert Nephrology(SA) Phys examination?

The official CMSA examination fee is R24 650.

What is the passing criteria for the examination?

Candidates must achieve an overall pass mark of 50%, with a 50% subminimum in each of the two components (the written component and the oral/OSCE/OSPE/clinical component).

What content areas are tested on the examination?

Content is weighted equally across 4 domains: Acute Kidney Injury & Critical Care Nephrology (25%), Glomerulonephritis & Systemic Diseases (25%), Chronic Kidney Disease & Dialysis (25%), and Renal Transplantation, Hypertension & Electrolyte Disorders (25%).