Renal · USMLE Step 1

USMLE Renal

Nephron physiology, acid-base disturbances, and classic renal pathologies.

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Normal glomerular filtration rate (GFR) in healthy adults
90-120 mL/min/1.73 m2
Which Starling force opposes glomerular filtration?
Oncotic pressure of plasma proteins (glomerular colloid osmotic pressure)
What is reabsorbed in the proximal convoluted tubule via active transport?
Glucose, amino acids, bicarbonate, and ions (Na+, K+, Cl-)
Proximal tubule reabsorbs 100% of filtered ____, amino acids, and bicarbonate under normal conditions
glucose
Describe water reabsorption in the descending loop of Henle
Water is freely reabsorbed via osmosis (aquaporin-1); the limb is permeable to water
The thick ascending limb of loop of Henle reabsorbs ____ but is impermeable to water
NaCl
Which diuretic class blocks the Na-K-2Cl cotransporter in the thick ascending limb?
Loop diuretics (furosemide, bumetanide, torsemide)
Where do thiazide diuretics work?
Distal convoluted tubule, blocking the Na-Cl cotransporter
What is the primary effect of ADH (vasopressin) on the collecting duct?
Increases water permeability by inserting aquaporin-2 channels into the apical membrane
Juxtaglomerular cells release renin in response to ____
decreased renal perfusion pressure
What are the three components of the filtration barrier?
Endothelial fenestrae, basement membrane, and podocyte foot processes (slit diaphragm)
Aldosterone increases sodium reabsorption in the ____ of the collecting duct
principal cells
How does creatinine clearance compare to inulin clearance?
Creatinine clearance slightly overestimates GFR because creatinine is secreted by proximal tubule cells
Define metabolic acidosis
Arterial pH less than 7.35 due to low bicarbonate (< 24 mEq/L) or high H+ concentration
Define metabolic alkalosis
Arterial pH greater than 7.45 due to high bicarbonate (> 24 mEq/L) or low H+ concentration

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