The SCE Nephrology is delivered as the European Specialty Examination in Nephrology (ESENeph), jointly administered with UEMS. It sits once per year, typically in June. The European format means some questions reflect pan-European practice, but the core guideline base is KDIGO supplemented by UK Kidney Association (UKKA) clinical practice guidelines.
Topic weighting
Glomerulonephritis accounts for approximately 14 per cent of the exam — the highest single domain. This includes primary glomerulonephritis (IgA nephropathy, membranous nephropathy, minimal change disease, FSGS, membranoproliferative GN), secondary glomerulonephritis (lupus nephritis, ANCA-associated vasculitis, anti-GBM disease, amyloidosis), and the ability to interpret described biopsy findings (mesangial IgA deposits, subepithelial deposits with spike formation, crescent formation) alongside clinical and serological data. If your glomerulonephritis knowledge is not comprehensive, you cannot pass this exam.
CKD management accounts for 14 per cent — classification (GFR and albuminuria), pharmacotherapy (RAS blockade, SGLT2 inhibitors, the initial eGFR dip), anaemia management (iron, ESAs, HIF-PHIs), CKD-MBD (phosphate binders, vitamin D, PTH targets), and the decision to refer for dialysis or transplant assessment.
AKI accounts for 10 per cent — KDIGO staging, pre-renal versus intrinsic versus post-renal differentiation, urinalysis interpretation, indications for urgent renal replacement therapy (refractory hyperkalaemia, severe metabolic acidosis, pulmonary oedema, uraemic pericarditis, uraemic encephalopathy). Transplantation accounts for 10 per cent — immunosuppression protocols (induction with basiliximab, maintenance with tacrolimus, mycophenolate, and prednisolone), rejection classification (antibody-mediated versus T-cell-mediated, Banff classification), post-transplant complications (BK nephropathy, CMV, PTLD), and long-term management.
Electrolyte and acid-base disorders account for 12 per cent — hyperkalaemia, hyponatraemia (SIADH versus psychogenic polydipsia versus adrenal insufficiency), hypercalcaemia, metabolic acidosis (anion gap calculation, renal tubular acidosis classification), and metabolic alkalosis. Haemodialysis and peritoneal dialysis account for a combined 12 per cent — modality selection, vascular access (fistula, graft, tunnelled line), dialysis adequacy (Kt/V), and complications (dialysis disequilibrium, peritonitis in PD).
The remaining questions cover hypertension (resistant hypertension, secondary causes, renal artery stenosis), diabetic kidney disease, polycystic kidney disease, renal stone disease, pregnancy and renal disease, and tubular disorders.
The glomerulonephritis depth problem
Most nephrology registrars have strong clinical experience with CKD, AKI, and dialysis from daily practice. Glomerulonephritis — the largest single domain — is often less familiar because many GN presentations are managed by the consultant with the registrar in a supporting role, and the biopsy interpretation pathway involves MDT discussion with pathologists rather than independent registrar decision-making.
The exam tests your ability to integrate clinical presentation, serological data (C3/C4, ANA, ANCA, anti-GBM, anti-PLA2R, serum free light chains), urinalysis (proteinuria quantification, microscopic haematuria, casts), and described biopsy findings into a diagnosis and management plan. This requires deliberate revision beyond what clinical exposure provides.
Revision strategy
Four months before the June sitting. Spend the first six weeks on glomerulonephritis and CKD management — these two domains alone account for nearly 30 per cent of the exam. Read KDIGO guidelines for each GN subtype alongside question bank practice. Weeks seven to ten should cover AKI, transplantation, and electrolyte disorders. Weeks eleven to fourteen should cover dialysis, remaining topics, and mock exams.
iatroX's SCE Nephrology bank contains over 1,500 questions aligned to KDIGO and UKKA guidelines. Glomerulonephritis questions include described biopsy findings, serological panels, and management decisions. Electrolyte and acid-base questions test calculation and classification. The adaptive algorithm ensures transplant immunology and the less familiar nephrology domains receive proportional attention. All included at £29 per month or £99 per year.