ESENeph (Nephrology Specialty Exam): question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Glomerular diseases — primary GN, secondary (lupus, vasculitis, monoclonal), nephrotic syndromes
• Acute kidney injury — KDIGO staging, contrast-AKI, hepatorenal, sepsis-related, drug-induced
• Chronic kidney disease — progression, anaemia (HIF-PHi, ESA), CKD-MBD, dietary management
• Dialysis — haemodialysis (vascular access, adequacy, complications), peritoneal dialysis
• Kidney transplantation — induction, maintenance IS, rejection (cellular, ABMR), CMV, BK, PTLD
• Tubular and interstitial diseases — AIN, ATN, inherited tubulopathies (Bartter, Gitelman, etc.)
• Electrolyte and acid-base disorders — Na, K, Ca, Mg, PO4, renal tubular acidosis
• Hypertension and renovascular disease — secondary HTN workup, FMD, renal artery stenosis
• Inherited kidney disease — ADPKD/ARPKD, Alport, Fabry, complement-mediated (C3G, aHUS)
• Renal pathology — recognising LM/IF/EM patterns, interpreting biopsy reports
• Statistics, ethics, professional, pregnancy and special populations

Drawn from current KDIGO guidelines, UKKA position statements and item density in iatroX.

• Glomerular disease — IgA nephropathy (MEST-C scoring, targeted-release budesonide [Nefecon], sparsentan), lupus nephritis (belimumab, voclosporin), ANCA vasculitis (avacopan, rituximab vs cyclophosphamide induction)
• AKI — KDIGO 2012/2024 staging, AKI bundles, contrast-induced nephropathy controversy, hepatorenal syndrome terlipressin + albumin, indications for emergency RRT (refractory hyperkalaemia, fluid overload, uraemia, acidosis, intoxications)
• CKD-MBD — calcimimetics (cinacalcet, etelcalcetide), active vitamin D, phosphate binders (iron-based, calcium-based, sevelamer, lanthanum), parathyroidectomy indications
• Anaemia in CKD — Hb targets per KDIGO/NICE, HIF-PHi agents (daprodustat, roxadustat) vs ESAs, IV iron protocols, hyporesponsiveness workup
• Transplant immunosuppression — tacrolimus + MMF + steroids standard, belatacept vs CNI long-term, recognising acute T-cell rejection (Banff classification) vs antibody-mediated rejection
• Complement-mediated disease — atypical HUS (eculizumab, ravulizumab), C3 glomerulopathy (iptacopan), classical HUS-STEC, TMA differential
• Pregnancy and kidney disease — GFR adaptation, pre-eclampsia BP targets per NICE NG133, lupus flare management, transplant pregnancy timing
• Inherited disease — ADPKD tolvaptan eligibility (TKV, eGFR), Fabry agalsidase/migalastat, Alport screening for relatives, genetic testing pathways

Observations from UK renal trainees and recent ESENeph candidates. Verify against current KDIGO and UKKA guidance.

Candidate-reported observations — not official guidance.

1. ESENeph tests European (UEMS / ERA) standards as well as UK practice. Many candidates over-rely on KDIGO and miss European-specific approaches in transplantation, dialysis access and rare disease management.
2. Renal pathology interpretation — distinguishing LM patterns (mesangial vs endocapillary vs crescentic), IF patterns (full-house vs pauci-immune vs linear vs granular) and EM (subepithelial humps, mesangial deposits, FPE). Histology images appear regularly.
3. Electrolyte disorders — Bartter vs Gitelman syndrome biochemistry, type 1 vs 2 vs 4 RTA acid-base patterns, Liddle vs Conn distinguishing features. Frequently muddled.
4. New biologics and targeted therapies — Nefecon (TRF-budesonide), sparsentan, avacopan, voclosporin, iptacopan. Trial designs and primary endpoints are tested directly.
5. Dialysis adequacy — Kt/V, URR, residual renal function preservation, peritoneal dialysis peritonitis organisms and management algorithms. Under-prepared by UK trainees with limited dialysis exposure.
6. Transplant infections — BK polyomavirus screening intervals, CMV prophylaxis vs pre-emptive, PTLD recognition, EBV-driven malignancy.
7. Statistics — survival analysis in transplant outcomes, hazard ratios in CKD progression trials, NNT for biologic therapies. Routinely tested.

A pragmatic phased approach used by recent UK passers in ST4–ST6 renal medicine.

1. Weeks 1–6

   Foundation pass across all 11 blueprint topics. 30 questions/day with the iatroX adaptive engine. Build histology pattern recognition early (LM, IF, EM patterns by disease). Comprehensive Clinical Nephrology (Feehally/Floege/Johnson) chapters paired to weak topics.

2. Weeks 7–11

   Targeted weak-area drilling. Map every recent KDIGO guideline (AKI 2024, CKD evaluation 2024, glomerular disease 2021, lipid management, anaemia, blood pressure) and UKKA position statements.

3. Weeks 12–14

   Two timed 200-SBA mock exams under exam conditions weekly. Practise histology and electrolyte panel interpretation under time pressure. The AJKD Atlas of Renal Pathology is invaluable here.

4. Weeks 15–16

   Bookmark review only. Targeted reading on new biologics (avacopan, sparsentan, Nefecon, iptacopan) and 2025 KDIGO updates. Confirm Pearson VUE booking. Sleep, hydrate, do not learn new material.

Dedicated ESENeph (Nephrology Specialty Exam) question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

From February 2020 the UK SCE in Nephrology and the European Certificate in Nephrology (UEMS Renal Section / ERA-EDTA) merged into a single exam: the European Specialty Examination in Nephrology (ESENeph). It is the GMC-approved mandatory summative knowledge assessment for UK renal medicine trainees as a requirement for CCT.

Next ESENeph sitting: 5 May 2027. Applications: 13 January 2027–10 February 2027. Applications open and close at 08:00 UK local time. Confirm booking and delivery arrangements with the Federation.

Two papers of 100 best-of-five SBAs each, three hours per paper, sat on the same day with a one-hour break between. Total 200 questions. From June 2026 all sittings are in-centre at designated test locations. Most questions are clinical case vignettes; some carry biopsy histology, electrolyte panels, ECG or radiology.

The UEMS Renal Section advises UK trainees dual-accrediting in General Internal Medicine and Nephrology to sit ESENeph during ST5 to allow time for up to 3 attempts before CCT. Single-accreditation candidates may sit in ST4. EU candidates typically take it towards the end of specialisation.

No. Candidates who have already passed the legacy SCE in Nephrology are not permitted to apply for ESENeph. The legacy SCE pass is sufficient for CCT purposes.

For candidates sitting in ESBGH/ESENeph member, associate member and observer countries the fee is €800. UK fee is £700; international fee is £875. Fees are non-refundable after the application closing date.

Full ESENeph (Nephrology Specialty Exam) bank access is included in all-access. Up to 10 new sample questions per day are shared across exams, with no account required. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.