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Nephrology
Certification Examination Blueprint
Purpose of the exam
The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified nephrologist in the broad domain of the discipline. The ability to make appropriate diagnostic and management decisions that have important consequences for patients will be assessed. The exam may require recognition of common as well as rare clinical problems for which patients may consult a certified nephrologist.
Exam content
Exam content is determined by a pre-established blueprint, or table of specifications. The blueprint is developed by the ABIM and is reviewed annually and updated as needed for currency. Trainees, training program directors, and certified practitioners in the discipline are surveyed periodically to provide feedback and inform the blueprinting process.
The primary medical content categories of the blueprint are shown below, with the percentage assigned to each for a typical exam:
Medical Content Category % of Exam Sodium and Water Abnormalities 8% Acid-Base and Potassium Disorders 9% Calcium, Phosphorus, and Magnesium Disorders and Stones 4% Chronic Kidney Disease 22% Hypertension 10% Tubular, Interstitial, and Cystic Disorders 4% Glomerular and Vascular Disorders 12% Kidney Transplantation 11% Pharmacology 5% Acute Kidney Injury and Intensive Care Unit Nephrology 15% 100%
Exam questions in the content areas above may also address clinical topics in adolescent medicine, critical care medicine, clinical epidemiology, geriatric medicine, and nutrition that are important to the practice of nephrology.
Exam format
The exam is composed of up to 240 single-best-answer multiple-choice questions, of which approximately 40 are new questions that do not count in the examinee’s score. Most questions describe patient scenarios and ask about the work done (that is, tasks performed) by physicians in the course of practice:
- Making a diagnosis
- Ordering and interpreting results of tests
- Recommending treatment or other patient care
- Assessing risk, determining prognosis, and applying principles from epidemiologic studies
- Understanding the underlying pathophysiology of disease and basic science knowledge applicable to patient care
Clinical information presented may include patient photographs, ultrasound images, angiograms, micrographs, radiographs, electrocardiograms, and other media to illustrate relevant patient findings. Learn more information on how exams are developed.
A tutorial including examples of ABIM exam question format can be found at http://www.abim.org/certification/exam-information/nephrology/exam-tutorial.aspx.
The blueprint can be expanded for additional detail as shown below. Each of the medical content categories is listed there, and below each major category are the content subsections and specific topics that may appear in the exam. Please note: actual exam content may vary.
Sodium and Water Abnormalities 8% of Exam
Hyponatremia 3% Hypotonic Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Hypervolemic Low solute intake Thiazides Other hypotonic (secondary adrenal insufficiency) Hypertonic Isotonic (pseudohyponatremia)
Metabolic alkalosis <2% Associated with normal or low blood pressure Renal origin Other metabolic alkalosis associated with normal or low blood pressure (chemotherapy-induced; hypokalemia; post-hypercapnic) Associated with high blood pressure Adrenal Other metabolic alkalosis associated with high blood pressure (malignant hypertension) Respiratory acid-base disturbances <2% Respiratory acidosis Respiratory alkalosis Mixed acid-base disturbances <2% Potassium disturbances 3.5% Hyperkalemia Pseudohyperkalemia Transcellular shifts Medication-induced Genetic abnormalities Other tubular disorders (hepatitis-associated) Postsurgical Other hyperkalemia (peritoneal dialysis) Hypokalemia Transcellular shifts Renal losses Nonrenal losses Other hypokalemia (combined therapeutic hypothermia and barbiturate coma)
Calcium, Phosphorus, and Magnesium Disorders and Stones 4% of Exam
Disorders of calcium metabolism < 2% Hypercalcemia Primary hyperparathyroidism Granulomatous diseases Malignancy Familial hypocalciuric hypercalcemia (FHH) Vitamin D toxicity Medications and vitamins Milk alkali syndrome
Hypocalcemia Hypoparathyroidism Pseudohypoparathyroidism Medications Tissue deposition Vitamin D deficiency Disorders of phosphate metabolism <2% Hyperphosphatemia Decreased renal excretion Increased intake Tissue redistribution Hypophosphatemia Increased renal excretion Decreased intake and gastrointestinal absorption Tissue redistribution Genetic causes Disorders of magnesium metabolism <2% Hypermagnesemia Decreased renal excretion Increased intake Hypomagnesemia Increased renal excretion Decreased gastrointestinal absorption Nephrolithiasis <2% Calcium stones Idiopathic hypercalciuria Hypocitraturia Hyperoxaluria Primary hyperparathyroidism Distal renal tubular acidosis Other calcium stones (medullary sponge kidney; hypercalciuria in hypoparathyroidism) Uric acid stones Idiopathic Other uric acid (postileostomy) Struvite stones Cystine stones Drug stones
Vascular access complications (clotting, dysfunction, infection) Other hemodialysis complications (embolism and thrombosis; heparin-induced thrombocytopenia; loss of residual renal function; hypoalbuminemia) Peritoneal dialysis Adequacy and prescription Dialysate Catheters Other peritoneal dialysis issues (hyperkalemia) Peritoneal dialysis complications Peritonitis and infections Ultrafiltration failure Other peritoneal dialysis complications (inguinal hernia; atrial fibrillation; peripheral edema) Home hemodialysis End-stage renal disease complications Anemia Cardiovascular disease Blood pressure abnormalities Other complications (hemolysis; hypoalbuminemia; thrombosis; calciphylaxis; uremic polyneuropathy) Medical director responsibilities and conditions of coverage Mineral bone disease 3% Laboratory abnormalities Hyperphosphatemia Hyperparathyroidism Other laboratory abnormalities (calcium balance) Renal osteodystrophy (and related pathophysiology) Osteitis fibrosis Adynamic bone disease Osteomalacia Mixed uremic osteodystrophy Other renal osteodystrophy, including low bone mass (osteoporosis) Extraosseous and vascular calcification Medial calcification Calciphylaxis Other extraosseous and vascular calcification, including visceral organs
Special topics in chronic kidney disease <2% Epidemiology Ethical considerations Pregnancy Laboratory studies Dermatology Nephrotoxicity of environmental and occupational agents Lead Organic solvents Other nephrotoxicity of environmental and occupational agents (cadmium; mercury) Other special topics in chronic kidney disease (obesity)
Hypertension 10% of Exam
Essential hypertension 3.5% Isolated systolic hypertension Severe hypertension Resistant hypertension White coat hypertension Pseudohypertension Masked hypertension Other essential hypertension (stage 2 hypertension; thiazide effect) Secondary causes of hypertension 4% Pheochromocytoma Renal vascular disease Dissection Atherosclerotic Hyperaldosteronism Adrenal adenoma Adrenal hyperplasia Genetic causes Liddle syndrome Dexamethasone suppressible hyperaldosteronism Other genetic causes (Hashimoto’s thyroiditis; scleroderma renal crisis) Miscellaneous causes Renin-secreting tumor (juxtaglomerular cell tumor) Syndrome of apparent mineralocorticoid excess Coarctation Vasculitis and arteritis
Renal cystic disease <2% Autosomal dominant polycystic kidney disease (ADPKD) Genetics Renal manifestations Nonrenal manifestations End-stage renal disease Drug-induced Renal mass <2%
Glomerular and Vascular Disorders 12% of Exam
Nephritic glomerular disorders, vasculitis, and vasculopathy 5% IgA nephropathy and Henoch-Schönlein purpura Vasculitis and antineutrophil cytoplasmic antibody Anti-glomerular basement membrane disease Lupus nephritis Postinfectious glomerulonephritis Membranoproliferative glomerulonephritis and C3 glomerulopathies Cryoglobulinemic glomerulonephritis Crescentic glomerulonephritis Other disorders (rapidly progressive glomerulonephritis) Nephrotic and heavy-proteinuric glomerular disorders 5% Minimal change disease Primary Secondary Focal segmental glomerulosclerosis Primary Secondary Genetic Membranous nephropathy Primary Secondary Paraprotein-related disorders Primary amyloidosis Secondary amyloidosis Light chain deposition disease and myeloma Other paraprotein-related disorders Fibrillary and immunotactoid glomerulonephritis Fabry’s disease Other disorders (biopsy complication)
Thin basement membrane nephropathy and Alport’s syndrome <2% Thrombotic microangiopathies <2% Hemolytic uremic syndrome <2% Shiga toxin-mediated hemolytic uremic syndrome Atypical hemolytic uremic syndrome Drug-associated atypical hemolytic uremic syndrome (anticancer drugs, clopidogrel, interferon, quinine) Other atypical hemolytic uremic syndrome (pregnancy-associated) Scleroderma renal disease <2%
Kidney Transplantation 11% of Exam
Pre-transplantation <2% Transplant immunology Detection of pre-transplant alloreactivity and immunologic evaluation of transplant candidates Potential kidney transplant recipient evaluation Glomerular filtration rate listing requirements Cancer concerns Infection concerns Cardiac concerns Age concerns Comorbidities Other potential kidney transplant recipient evaluation (recurrent autoimmune kidney disease) Potential living kidney donor Donor evaluation Risks Ethics Organ allocation Deceased donor wait list Organ shortage strategies Paired kidney donation and chains Transplantation <2% Indications Contraindications Deceased donor kidney transplantation Types Outcomes
Nephrotoxicity of medications 2% Principles and mechanisms of nephrotoxicity Antibacterial agents Aminoglycosides Vancomycin Antiviral agents Antifungal agents Antiparasitic agents Additional antimicrobials Pain medications Nonsteroidal anti-inflammatory drugs Fentanyl Gabapentin Tramadol Renin-angiotensin-aldosterone system (RAAS) blockade Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and renin inhibitors Aldosterone antagonists Antihypertensive agents Beta-adrenergic blockers Calcium channel blockers Minoxidil Antineoplastic chemotherapy agents Interferon Cisplatin Methotrexate Vascular endothelial growth factor inhibitors Immune checkpoint inhibitors Iodinated contrast and other imaging agents Lithium Supplements and herbs Aristolochic acid SGLT2 inhibitors Other nephrotoxicity of medications (cardiac glycosides; bisphosphonates) Nephrotoxicity of illicit drugs <2% Heroin and other intravenous drugs Ecstasy Cocaine Drug-drug interactions and adverse effects other than nephrotoxicity <2%
Dialysis and other treatment of toxic substances <2% Ethylene glycol Methanol Other alcohols Lithium Other dialysis and treatment of toxic substances (salicylates; dialysis duration prescription)
Acute Kidney Injury and Intensive Care Unit Nephrology 15% of Exam
Hemodynamic (prerenal) acute kidney injury 4% True volume depletion Renal Extrarenal Effective volume depletion Heart failure Cirrhosis Nephrotic syndrome Drugs Nonsteroidal anti-inflammatory drugs Calcineurin inhibitors Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers Radiocontrast agents Other drugs (anticoagulants; interferon) Abdominal compartment syndrome Parenchymal (intrinsic) acute kidney injury 4.5% Vascular Systemic diseases and vasculitis Atheroemboli Renal vein thrombosis Glomerular Drug-induced Infectious Other glomerular parenchymal acute kidney injury (relapsed microscopic polyangiitis) Tubular Ischemic Nephrotoxic Systemic disease
