Mastering Renal Physiology for USMLE: High-Yield Concepts and
Detailed Explanations for Success 2024/2025
Complete USMLE Renal Physiology Review: Key Concepts, Detailed
Insights, and High-Yield Content
Which of the following is a true statement?
A Renin is released by the JG cells when it senses high blood pressure
B Angiotensin conveting enzyme is found pimaily in the kidneys
C Aldosterone acts on the intercalated cells
D Angiotensin II acts on the proximal tubule
E None of the above
D is correct
A - false, Renin is released when there is low blood pressure (hypovolemia) B - false, ACE is found and
pimaily made in the lungs. C - false, Aldosterone acts on the pincipal cells D - Corect answer -
Angiotensin II acts on the proximal tubule to increase NA & H2O reabsorption
Which part of the nephron is targeted by thiazide diuretics such as chlothalidone?
A The early distal convoluted tubule Na/Cl co-transpoter)
B The thick ascending loop of Henle Na/K/2Cl cotranspoter)
C The late distal convoluted tubule Na/K countetranspoter)
D The proximal convoluted tubule Na/K countetranspoter)
A is correct
,A - The early DCT is the target for thiazides, which decreases Na reabsorption. B - the loop of henle is the
target for loop diuretics such as furosemide Lasix). C - The late DCT is the target for aldosterone
antagonists such as spironolactone. ACEs and ARBs also indirectly affect the DCT by decreasing
aldosterone production. D - The PCT is the site of action for carbonic anhydrase inhibitors such as
acetazolamide
Increases in both renal blood flow and GFR are caused by which of the following?
A Dilation of the afferent ateioles
B Increased glomeular capillay filtration coefficient
C Increased plasma colloid osmotic pressure
D Dilation of the efferent ateioles
E Increased blood viscosity due to increased hematocit
A: Dilation of the afferent arteioles
Which of these is true regarding the collecting ducts
A Responsible for finalization of uine
B Where the effects of ADH occur
C A site of resorption
D Regulation of acid/base
E All of the above
E All of the above
Which of these is a false statement?
A JGA is responsible for the release of renin
B Angiotensin I is directly responsible for reabsorption of salt and water
C ADH increase the number of aquapoins in the collecting duct
D Atial natiuretic peptide works in the opposite of Aldosterone
,E None of the above
B. Aldosterone release is activated by Angiotensin II which is conveted from Angiotensin I. Aldosterone is
directly responsible for reabsorption of salt and water. Aldosterone is activated by Angiotensin II which
was conveted from Angiotensin I (by ACE in lungs).
Regarding how the renal system acts as a buffering system, which of these is a false statement?
A Removal (secretion) of H through uine
B Generation of new bicarb
C Resoption of filtered bicarb
D Excretion of CO2
E None of the above
D Excretion of CO2
22yo female presents with altered mental status. You run a CMP and notice hyponatremia with a low
BUN. Her fiend who brought her in said she suffered a head injuy due to crashing her bike this moning.
What is the most likely diagnosis?
A Central diabetes insipidus
B Nephrogenic diabetes insipidus
C SIADH
D Psychogenic polydipsia
the answer here is syndrome of inappropiate ADH SIADH. SIADH in the setting of HEAD TRAUMA (can
also be due to stroke, CNS tumor, Small cell lung Cancer).Too much ADH is being excreted, causing
increased free water
retention and impaired water excretion -→ hyponatremia/kidney unable to dilute uine. Confusion came
from symptomatic hyponatremia (neurologic sxs d/t cerebral edema - edema is d/t relative hypotonicity
of ECF shifting water into cells).
Diabetes insipidus is also caused by head trauma. However, you would get decreased oral free water
intake → hypenatremia. Kidneys cannot concentrate uine -→ produces large amounts of DILUTE uine.
, The urine of a pt with DECREASED GFR, will be____________
A More dilute
B More concentrated
C Unchanged
D Blue
A More dilute
if GFR is low → volume of filtrate is low → fluid is going to move through renal tubule SLOWLY →
provides more access and more time for solute to be resorbed
371. A 16-year-old girl presents for her annual high school athletic physical. She states that she seems
more tired than usual, she has been having muscle cramps in her
calves, and her legs get very weak and sore after running and playing soccer. Her blood pressure is
160/100 mm Hg, and her ECG shows a prolonged QT interval and
the presence of a U wave. Blood analysis shows hypokalemia, metabolic alkalosis, and decreases in
plasma renin activity and aldosterone concentration. Her clinical
condition is reversed after she is placed on the diuretic amiloride. Based on this finding, which of the
following renal transport processes is the major defect causing her
metabolic disorder?
a. Greater than normal sodium reabsorption by the proximal tubules
b. Greater than normal sodium reabsorption by the cortical collecting ducts
c. Inability of the distal nephron to secrete hydrogen
d. Inability of the distal nephron to secrete potassium ion
e. Inability to concentrate urine
The answer is b.
372. A previously well 12-year-old boy is brought to the emergency department with vomiting and
severe abdominal cramps after a prolonged period of exercise.
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