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Your degree is FNP, therefore you can only take FNP certifcation exam. If you try applying for AGNP exam, it will be rejected. https://www.aanpcert.org/resource/documents/AGNP FNP Candidate Handbook.pdf Yes you can work in nephrology clinic with an FNP. I dont think you need to worry. Take the FNP exam. Find a job in nephrology. You don't need to work with pediatrics.

I forgot to mention that with CKD 1-5, the #1 cause is diabetes / diabetic nephropathy at about 45%. #2 cause is HTN / hypertensive nephrosclerosis at about 25%. That makes up about 70% of the cause for chronic kidney disease. The other 30% come from other causes like cardiorenal syndrome, ADPKD, glomerulnephritis, nephrotoxin use like chronic nsaids, iodine contrast and aminoglycosides, tubulointerstitial nephritis, ATN, acute on chronic, obstruction leading to hydronephrosis. Also review normal age related changes. Kidney function/eGFR typically decreases by 1cc/min each year after age 40 and let's say we all start off at 100cc/min. That will be important to note when you see older patients, for example in patients 80 years old and over, their kidney function may fall in the 50-60cc/min range, which is identified as CKD 3, however, they may not have CKD at all.

Congrats on the new position cheights! I recommend reading the Handbook of Dialysis by John T. Daugirdas, MD. It’s a good resource for hemodialysis and peritoneal dialysis. Also see previous comments by traumaRus. Just like any other specialty, it will take time to learn things. At least for me it took several months to really be comfortable seeing dialysis patients on my own. To help in understand why we manage dialysis patients the we do is to first know the kidneys do. The kidneys have 5 main functions. 1. Filters fluid, electrolytes and toxins 2) Sodium and water balance by way of RAAS 3) Erythropoietin production 4) Helps activate vitamin d by 1 alpha hydroxylase 5) Acid base balance. When the kidneys fail, these functions stop working and complications develop such as 1) uremia 2) fluid overload, difficult to control BP 3) anemia of CKD 4) renal osteodystrophy and 5) metabolic acidosis. Thus renal replacement therapies such as HD, PD or kidney transplant help replace those functions to reduce complications. There are goals for each of these areas. Review guidelines by KDOQI/KDIGO https://www.kidney.org/professionals/guidelines/guidelines_commentaries For outpatient clinic- I recommend reviewing CKD 1-5. This will be your bread and butter. I will attach a resource that I think is helpful: CKD.pdf and Practical Approach to CKD.pdf. I also recommend reading up on other renal conditions like cardiorenal syndrome, hepatorenal syndrome, hypo/hypernatremia, hypo/hyperkalemia, renal tubular acidosis, metabolic acidosis, hypercalcemia, IGA nephropathy, polycystic kidney disease, management of kidney transplant patients, persistent proteinuria, resistant HTN. Something I do in clinic is I always write out labs- electrolytes in fish diagram. I found this helpful when reviewing labs. You will get used to looking and reporting labs as NA, K, Cl, CO2, BUN, Scr, eGFR, Glucose, Ca, Phos, Alb. You will probably be doing a lot of BP management as well. Find out which BP guidelines your organizations follows like JNC7, JNC8, ANA/ACC, etc. Review your first line BP agents, second line and so on. Think ABCs (A) ACEI/ARBs (B) Beta Blockers (these are actually 3rd line agents, however it can be used if the patient is post MI, CHF and for resistant HTN) (C) Calcium channel blockers: Non DHPs and DHPs (D) Diuretics: Thiazides, Loops , MRAs, ENaC blockers. Then you have other agents such as centrally acting adrenergic agonists like methyldopa and clonidine, direct vasodilators like hydralazine which you will see often in our dialysis patients and resistant HTN. In some cases where you have patients on 4 meds maxed out and still with very high BP, consider work up for secondary HTN. The patients that are being referred to you will not have 1 or 2 blood pressure meds. They will be coming to you with 3 or 4 already on board. Consider risk/benefit ratio and keep in mind the importance of knowing when to treat and also knowing when not to treat. Check if your employer provides Uptodate. I use this website and phone app often to look things up. Also recommend signing up to be a member of NKF. They give you a free book on kidney diseases called NKF Primer on Kidney Diseases.

That's great to hear. It's definitely possible to enter the field after passing boards. I didn't have any prior nephrology or NP experience. I worked as an RN in med-surg for abt 3 years. How was the experience with the internal med/nephro doc? I agree with TraumaRUs- network as much as possible, it will be helpful in getting that first job. Try professors, clinical instructors and other APRNs. And yes, join your state APRN organization. I used to go to CANP meetings, California Association for Nurse Practitioners. It was a great way to meet with other NPs from all backgrounds. Check out the national kidney foundation website-click the professionals tab- great resource. Since you had most of your clinical hours with the nephro doc, did you already try talking to them to let them know your interest? If anything, they might be able to direct you to other nephro docs/groups who would be interested in an NP.

Hello, I took this exam/passed today. The exam was 175 questions and 4 hours long. I studied a lot using uptodate and other online materials but I recommend reviewing the Handbook of Dialysis by John T. Daugirdas and also reviewing the Henryford HealthSystem CKD for PCPs which is a good review on CKD. most questions were on HD, complications, access issues, some on CCRT, more on PD, some on HD/pregnancy, medications r/t to dialysis, medications r/t to kidney transplants, CKD 1-5, AKIs, the different glomerulonephritis, few on nephrotic syndrome vs nephritic, few on hereditary kidney diseases, several scenario based questions. overall, the test was average, not terrible but not great either. I felt the questions could have been worded better. Some questions/answers just seemed so ambiguous to me, it was kind of frustrating. There was an option to comment on certain questions which I did. And some questions seemed to be so far off out there, like the question maker opened up a nephro book to a random page, pointed to a sentence and made that into a question. Or maybe I just haven't been working in nephrology long enough to know certain things, I am 1 year this week. Anyway hope some of this info helps!

Hi traumaRUs, I tried to send PM but it won't let me since I haven't created the minimum amount of topics

Hi here is an update. So I took the nephrology position and I am currently 6-7 months in. So far it's been a good learning experience. Lately I have been missing the acute care/hospital setting but I plan to stick with this and take the cnn-np cert in dec when I have enough hours. Rounding at the dialysis centers is just as traumaRUs described it in the earlier post. if any of that sounds interesting, nephrology may be a good option. I do like the fact that I am not in an office all day and I get to drive to the different centers. A neat thing I got to learn was to write/order chronic dialysis prescriptions. in addition to rounding, I also see some patients in outpatient clinic, majority of them for CKD 1-5. Some other interesting ones that I am still learning about are lupus nephritis, hypo/hypernatremias, s/p kidney transplants.

Thank you for the thorough and descriptive reply, I appreciate that! The information is very helpful. And thanks for the heads up on on CMS and AKIs. I have a few more questions and will ask them here in case anyone else is curious also. Since you have been working as a nephrology APRN for 11.5 years, what are the things you enjoy about working in this area? Is there anything you don't like so much? Regarding #3 with the 4 patient visits, how do you space out the visits. I am guessing you see them once per week? You mentioned that one visit is usually done by the MD and the other three can be by the NP/PA-- does that mean the NP/PA essentially sees a patients for 3 weeks and is off the 4th week when the MD makes their visit? In your practice do you manage any acute/primary care issues of patients or do you refer them to their pcp?

Hello, so I just got offered a position at an educational institution seeing patients for outpatient dialysis. I graduated in June 2017 and this will be my first job. The nephrologist said he would train me for 3-6months and go from there depending on my comfort level. I'm still filling out paperwork and doing background check, so I won't start for another month or two. I plan to just review all things renal in the meantime. Can anyone tell me what their day is like as a nephrology NP? Do you have any suggestions/advice/tips regarding this specialty as well as starting out as a new NP? Thank you so much.