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Format: Computer-based testing (CBT) at PSI Testing Centers or paper-and-pencil testing (if requested).
Number of Questions: 175 multiple-choice questions.
Duration: 4 hours.
Passing Score: A standard score of 95- achieved by correctly answering at least 70% of the questions (approximately 123 questions)

1. Concepts of Kidney Disease (Approximately 10–14% of the Exam)
This section assesses foundational knowledge of renal anatomy- physiology- and pathophysiology- as well as the management of kidney disease.

Renal Anatomy and Physiology:
Structure and function of the kidneys (e.g.- nephron- filtration- reabsorption- secretion)
Regulation of fluid- electrolyte- and acid-base balance
Hormonal functions of the kidney (e.g.- erythropoietin- renin- vitamin D activation)
Pathophysiology of Kidney Diseases:
Acute冰: Acute kidney injury (AKI)- chronic kidney disease (CKD)- end-stage renal disease (ESRD)
Glomerular diseases (e.g.- glomerulonephritis- nephrotic syndrome)
Tubulointerstitial diseases
Genetic disorders (e.g.- polycystic kidney disease)
Secondary causes of kidney disease (e.g.- diabetes- hypertension- autoimmune disorders)
Assessment and Diagnosis:
Clinical presentation of kidney diseases
Diagnostic tools (e.g.- urinalysis- serum creatinine- glomerular filtration rate (GFR) estimation- imaging- biopsy)
Staging and classification of kidney disease (e.g.- CKD stages 1–5)
Management Principles:
Non-dialytic management of CKD (e.g.- dietary modifications- blood pressure control- glycemic control)
Patient education on disease progression and lifestyle modifications

2. Hemodialysis (Approximately 25–30% of the Exam)
This section focuses on the principles and management of hemodialysis- a common kidney replacement therapy.
Principles of Hemodialysis:
Dialysis process (e.g.- diffusion- ultrafiltration)
Vascular access types (e.g.- arteriovenous fistula- graft- catheter)
Dialyzer types and characteristics
Patient Management:
Pre-dialysis exam (e.g.- weight- vital signs- access evaluation)
Monitoring during dialysis (e.g.- blood pressure- fluid removal- complications like hypotension or cramping)
Post-dialysis evaluation and follow-up
Complications and Interventions:
Access-related complications (e.g.- infection- thrombosis- stenosis)
Dialysis-related complications (e.g.- disequilibrium syndrome- amyloidosis)
Medication management (e.g.- anticoagulants- erythropoiesis-stimulating agents)
Pharmacology:
Medications commonly used in hemodialysis patients (e.g.- phosphate binders- calcimimetics- iron supplements)
Drug dosing adjustments for reduced renal function

3. Peritoneal Dialysis (Approximately 15–20% of the Exam)
This section covers the management of patients undergoing peritoneal dialysis- an alternative to hemodialysis.
Principles of Peritoneal Dialysis:
Types (e.g.- continuous ambulatory peritoneal dialysis (CAPD)- automated peritoneal dialysis (APD))
Peritoneal membrane characteristics and transport rates
Dialysate composition and dwell times
Patient Management:
Catheter placement and care
Training patients for home dialysis
Monitoring for adequacy (e.g.- Kt/V- peritoneal equilibration test)
Complications and Interventions:
Infectious complications (e.g.- peritonitis- exit-site infections)
Non-infectious complications (e.g.- hernias- membrane failure)
Fluid and electrolyte imbalances
Pharmacology:
Antibiotics for peritonitis
Adjustments for peritoneal dialysis patients

4. Kidney Transplantation (Approximately 10–15% of the Exam)
This section evaluates knowledge of kidney transplantation processes and post-transplant care.
Pre-Transplant Evaluation:
Candidate selection and workup
Donor evaluation (living vs. deceased donors)
Immunologic considerations (e.g.- HLA matching- crossmatching)
Transplant Procedure:
Surgical considerations
Immunosuppressive therapy initiation
Post-Transplant Management:
Monitoring for rejection (acute and chronic)
Immunosuppressive regimens (e.g.- calcineurin inhibitors- corticosteroids- antimetabolites)
Complications (e.g.- infection- malignancy- cardiovascular disease)
Long-term follow-up and graft survival
Pharmacology:
Immunosuppressants (e.g.- tacrolimus- mycophenolate- prednisone)
Prophylactic medications (e.g.- antivirals- antifungals)

5. Acute Therapies (Approximately 5–10% of the Exam)
This section addresses acute kidney injury and therapies used in critical care settings.
Acute Kidney Injury (AKI):
Causes (e.g.- prerenal- intrinsic- postrenal)
Diagnostic evaluation (e.g.- fractional excretion of sodium- ultrasound)
Management (e.g.- fluid resuscitation- avoidance of nephrotoxins)
Continuous Renal Replacement Therapies (CRRT):
Modalities (e.g.- continuous venovenous hemofiltration (CVVH)- hemodiafiltration (CVVHDF))
Indications (e.g.- AKI in critically ill patients- sepsis)
Anticoagulation strategies
Other Acute Therapies:
Plasmapheresis for renal-related conditions (e.g.- glomerulonephritis- transplant rejection)
Management of electrolyte emergencies (e.g.- hyperkalemia- hyponatremia)

6. Pharmacology (Integrated Across All Sections- Approximately 10–15%)
Pharmacology is a cross-cutting topic- with questions integrated into the above sections. Key areas include:
Medications for Kidney Disease:
Antihypertensives (e.g.- ACE inhibitors- ARBs)
Diuretics
Phosphate binders- vitamin D analogs- and calcimimetics for mineral and bone disorders
Erythropoiesis-stimulating agents and iron therapy for anemia
Dosing Adjustments:
Adjustments for reduced renal clearance
Dialyzability of medications
Adverse Effects and Interactions:
Nephrotoxicity of drugs (e.g.- NSAIDs- aminoglycosides)
Drug-drug interactions in patients with comorbidities

7. Professional Practice and Patient Education (Approximately 5–10%)
This section covers the nurse practitioners role in patient care and professional responsibilities.
Patient Education:
Teaching patients about disease processes- treatment options- and lifestyle modifications
Supporting adherence to dialysis schedules and medications
Providing resources for transplant preparation and follow-up
Ethical and Legal Considerations:
Informed consent for procedures
End-of-life care and advance directives in ESRD
Scope of practice for nephrology nurse practitioners
Collaboration:
Working with interdisciplinary teams (e.g.- nephrologists- dietitians- social workers)
Referrals to specialists (e.g.- vascular surgeons- transplant coordinators)