Free European Specialty Examination in Nephrology Practice Questions

Sample Practice Questions

Try these 10 sample questions from the European Specialty Examination in Nephrology practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 46-year-old with new nephrotic syndrome has preserved kidney function and no atypical clinical features. Which positive serological result can establish membranous nephropathy without a diagnostic kidney biopsy?

   1. A.Anti-PLA2R antibodiesCorrect answer: A
   2. B.Anti-MPO antibodies
   3. C.Anti-GBM antibodies
   4. D.Anti-dsDNA antibodies

   Explanation: KDIGO states: "A kidney biopsy is not required to confirm the diagnosis of membranous nephropathy (MN) in patients with nephrotic syndrome and a positive anti-PLA2R antibody test." This presentation meets that diagnostic combination; the other antibodies do not provide this biopsy exemption.

   Reference: KDIGO Glomerular Diseases Guideline — p. S50

2. 2A patient's creatinine increases from 90 to 210 micromol/L within four days. Urine output is preserved, creatinine remains below 353.6 micromol/L, and dialysis has not been started. Which KDIGO AKI category applies?

   1. A.No acute kidney injury
   2. B.Stage 1 acute kidney injury
   3. C.Stage 2 acute kidney injuryCorrect answer: C
   4. D.Stage 3 acute kidney injury

   Explanation: The guideline states: "2.0–2.9 times baseline" The ratio is 210/90 = 2.33, meeting stage 2. Stage 1 is a smaller rise; stage 3 requires a higher ratio or another stage-3 criterion.

   Reference: KDIGO Acute Kidney Injury Guideline — Recommendation 2.1.2, Table 2

3. 3An adult's reduced eGFR has persisted on repeat measurements, with no earlier records or other evidence of chronicity. What minimum duration establishes chronic kidney disease rather than an acute disorder?

   1. A.1 month
   2. B.2 months
   3. C.3 monthsCorrect answer: C
   4. D.6 months

   Explanation: KDIGO states: "Proof of chronicity (duration of a minimum of 3 months)" Three months is the minimum duration. A single abnormal result cannot by itself establish chronicity.

   Reference: KDIGO Evaluation and Management of CKD Guideline — p. S149

4. 4A patient with anaemia on maintenance haemodialysis has iron deficiency and is starting iron replacement. There is no active infection. Which preparation and route accords with KDIGO's preferred route for this population?

   1. A.Daily ferrous sulfate by oral administration
   2. B.Daily ferric maltol by oral administration
   3. C.Daily ferrous fumarate by oral administration
   4. D.Iron sucrose by intravenous administrationCorrect answer: D

   Explanation: KDIGO states: "we suggest using intravenous (i.v.) iron rather than oral iron" Intravenous iron is preferred when starting replacement in CKD G5 receiving haemodialysis. The competing preparations all provide oral iron.

   Reference: KDIGO Anemia in CKD Guideline — Recommendation 2.2

5. 5A non-transplant adult with hypertension and nondialysis CKD tolerates intensive treatment. Using standardised office measurements, what systolic target does KDIGO suggest?

   1. A.Below 130 mmHg
   2. B.Below 140 mmHg
   3. C.Below 120 mmHgCorrect answer: C
   4. D.Below 150 mmHg

   Explanation: KDIGO states: "a target systolic blood pressure (SBP) of <120 mm Hg, when tolerated, using standardized office BP measurement" The suggested target is below 120 mmHg under standardised measurement when tolerated. This target must not be applied indiscriminately to casual readings.

   Reference: KDIGO Blood Pressure in CKD Guideline — p. S24

6. 6An adult with ADPKD is at risk of rapid disease progression and is being assessed for tolvaptan. What minimum eGFR is specified in KDIGO's initiation recommendation?

   1. A.15 mL/min/1.73 m²
   2. B.20 mL/min/1.73 m²
   3. C.25 mL/min/1.73 m²Correct answer: C
   4. D.30 mL/min/1.73 m²

   Explanation: The source states: "initiating tolvaptan treatment in adults with ADPKD with an estimated glomerular filtration rate (eGFR) ‡25 ml/min per 1.73 m2 who are at risk for rapidly progressive disease" The initiation threshold is 25 mL/min/1.73 m², together with rapid-progression risk, not eGFR alone.

   Reference: KDIGO ADPKD Guideline — p. S35

7. 7A patient on PD has abdominal pain and cloudy effluent after a three-hour dwell. Effluent white cells exceed 100/µL. What minimum percentage cutoff must the PMN proportion exceed to meet the ISPD differential-count criterion?

   1. A.10%
   2. B.25%
   3. C.50%Correct answer: C
   4. D.75%

   Explanation: ISPD states: "with > 50% polymorphonuclear leukocytes (PMN)" The criterion uses a PMN proportion greater than 50%, together with the cell-count and dwell-time conditions. This is the cutoff, not a claim that a higher PMN percentage fails the criterion.

   Reference: ISPD Peritonitis Guideline Recommendations — Peritonitis diagnosis, diagnostic criteria

8. 8An adult receives thrice-weekly haemodialysis with no measured residual kidney contribution. What minimum equilibrated Kt/V does the UK haemodialysis guideline target consistently?

   1. A.1.0
   2. B.1.4
   3. C.1.2Correct answer: C
   4. D.1.6

   Explanation: The UK guideline states: "a minimum eKt/V of 1.2 for thrice weekly patients, in the absence of a measured contribution from residual function." The minimum equilibrated Kt/V is 1.2. Equilibrated and single-pool Kt/V values should not be interchanged.

   Reference: Renal Association Clinical Practice Guideline: Haemodialysis — Dialysis dose in thrice-weekly dialysis schedules

9. 9A kidney transplant recipient has a persistent creatinine rise despite correction of volume depletion. Ultrasound excludes obstruction and vascular compromise, and drug exposure does not explain the change. Which investigation is recommended next to establish the graft pathology?

   1. A.Repeat plain abdominal radiography
   2. B.Serum anti-PLA2R antibody testing
   3. C.Kidney allograft tissue biopsyCorrect answer: C
   4. D.Urinary sodium concentration testing

   Explanation: KDIGO states: "We recommend kidney allograft biopsy when there is a persistent, unexplained increase in serum creatinine." Biopsy is recommended for a persistent unexplained rise after reversible causes are assessed; the other tests do not establish the graft pathology.

   Reference: KDIGO Care of Kidney Transplant Recipients Guideline — Recommendation 9.1

10. 10An adult taking metformin has a persistent eGFR decline. Below which eGFR does KDIGO's dosing algorithm advise stopping metformin and not initiating it?

    1. A.15 mL/min/1.73 m²
    2. B.20 mL/min/1.73 m²
    3. C.30 mL/min/1.73 m²Correct answer: C
    4. D.45 mL/min/1.73 m²

    Explanation: The source states: "Stop metformin; do not initiate metformin" The stop/do-not-start branch applies below 30 mL/min/1.73 m². This medication-specific threshold differs from SGLT2-inhibitor recommendations.

    Reference: KDIGO Diabetes Management in CKD Guideline — Figure 27, eGFR below 30 branch