USMLE Step 1 - Renal Physiology [High Yield BRS Concepts]

[@Medicalguideline-j4t]

Dr sab sta da teaching method hu dera maza Kaye wallah enjoy hum aw study hum,❤️❤️

[@danieldonascimentoaraujo3221]

HY Points -Madulla (Kidney) has lower PaO2 - More susceptible to Ischemic Damage [ Has Long Capillary loops Surrouinding the Loop of Henle --> Vasa Recta] Slow flow through "Vasa Recta" keep PaO2 of Medulla < Renal Cortex -PCT (HIgh metabolic activity) is also more pron to Ischemic Injury -Medulla - portion of Nephro more Hyperosmotic / Loop of Hele reabsorbs a lot of Electrolytes (Counter-Current Multiplier System) -Cortex (Kidney) is relatively Iso-Osmotic with Plasma -Kidney's receive 25% of Cardiac Output -Normal RBF is about 1.1 L/min (~4.5 L Cardiac Output - Nomral Heart) -Excretion = (Filtration - reabsorption ) + Secretion -↑Efferent Arteriolar Resistance -> ↑Capillary Glomerular Oncotic Pressure in Peritubular Capillaries-> ↑GFR->↑Peritubular Capillary fluid/ions Reabsorption (+ ↓Peritubullar art Hydrostatic Pressure) (e.g. Angiotensin I I--> Efferent Arteriolar Constriction ) -Diabetes --> NEG of the Efferent Arteriole --> ↑Efferent Arteriolar Resistance --> Prolif Mesangium/Albuminuria -NSAIDs ↓Prostaglandins --> ↓Vasodilation of Afferent Arteriole --> ↓Glomerular Hydrostatic Pressure --> ↓GFR -Normal GFR 120 mL/min. Ideal Substance is "Inulin" (Filtered but NOT reabsorbed or secreted) -Terminal Collecting duct -> Highest conctration of Inulin. Bowman's Space -->Lowest concentration -Creatinine will OverStimate the GFR about 10% (Filtered and Secreted ) -Normal Renal Plasma Flow (RPF) --> 600 mL/min. Para-Amino-Hippuric Acid (PAH) is a good marker for RPF -Normal Renal Filtration Fraction is 20% -Patient with low BP (Hypotensive) --> Activation of RAAS --> ↑Peritubular Oncotic Pressure -Nepholithiasis with Hydronephrosis --> ↑Hydrostatic PRessure of the interstitial Fluid/Bownman's Space & ↓GFR + NO change in RPF (early) and ↓Filtration Fraction -Hyperglycemia --> Low affinitiy Na+/Glucose co-transporter (SGLT-2) & Heterogeneity of Nephrons --> Glycosuria -SGLT-2 inhibitors (e.g. Canagliflozin, Dapaglifozin, empagliflozin ) ↓reabsorption of Glucosie -> Glycosuria -2/3 of Na+ reabsorbed in PCT (Sodium coupled to glucose, AA, Lactate, PO4, K+, cl-, H2O, Uric acid) 2nd Active Transport -Sympathetic Nervous System Upregulates Na+/K+ ATPase Basolateral channels in PCT --> ↑Na+ reabsorption -K+/Cl- are also reabsorbed via Paracellular transport in PCT -Majority of filtrate fluid at the End of PCT is Iso-Osmotic -Reabsorption of Filtered HCO3- in PCT occur via Luminal/Intracellular Carbonic Anhydrase -Descending Limb of Henle --> Permeable to Water NOT permeable to Solute. -Thick Ascending limb --> Permeable to solute. NOT permeable to water -Loope Diuretic (e.g. Furosemide/Ehtacrynic Acid) inhibit Na+/K+/2cL-at "Thick Ascending Limb" -Thiazide inhibits Na+/cL- Symporter at "DISTAL TUBULE". -Distal Tubule is IMPERBLEABLE to Water. -PTH stimualtes Ca2+ reabsorption at Distal tubule -Aldosterone Stimualtes upregulation of ENaC channels in the Principal cells of Collecting Duct -->Na+ reabsorption [High Aldosterone --> HyperNatremia, Hypokalemia and Alkalosis (↑pH) (low Hydrogen ion activity in Plasma)] -"Conn Syndrome" --> Primary HeperAndosteronism -ADH via V2 (Gs-Protein coupled Pathway) receptors induces insertion of Aquaporins at Principal Cells of Collecting duct -Arginine is the AA precursor to ADH -Aldosterone upregulates "H+ ATPase" at Intercalated cells --> H+ Loss in urine

[@S.Aijaz29.]

Awesome

[@unitedred1999]

Love your enthusiasm man. It is infectious. 😂🤘

[@ifyndie9523]

You are simply amazing!!! Thank you for taking out time to teach and doing it cheerfully!!!!

[@sr689]

Thank you for making it easy. I am med 2 student.

[@dannyotuwa686]

His physio vids and robbins is perfect for step prep. Pathoma for pathology, sketchy/anki for bugs and drugs, then Uworld to top it off is my combo.

[@shaunmathew]

Hey, was the combo you mentioned helpful for your step?

[@dannyotuwa686]

@@shaunmathew yes! With uworld being the most important. Finishing should be your priority. I dedicated a week to watch sketchy micro and did the anki deck for the video right after watching

[@shaunmathew]

@@dannyotuwa686 Awesome, thanks for the update.

[@JustShort338]

Your enthusiasm to teach is infective!!

[@tereydagomezflores7007]

what a lovely energy ... thank you so much .. greetings from colombia

[@mirandacosgroveey]

I love the passion you put to teach! You make difficult subjects so easy to understand 🥰

[@hyguruprep]

Thank you so much!

[@heavythinker16]

Wow...I didnt get bored one second watching this. Learned a lot!

[@hyguruprep]

thanks so much - this truly inspires me!

[@gholamrezaabdollahinejad4759]

Hi dr Raul ,I m from iran.thanks alot.you are wonderful

[@teklanatidze5904]

u r amazing. you just helped me to study whole physio in 1 hour ♥ thank u so much ♥♥

[@abby6713]

would you say his videos are good comprehensive review of what will be covered on the Physiology NBME? If you have taken it (lol).

[@mairajamal4953]

Thank u sooo much !!!! This helped me so much for reviewing !!

[@Raghadkhamis-qe5hp]

you are amazing, would appreciate a renal pathology video too

[@fawzaljanabi]

You are amazing ❤thank you for your help

[@jadeloberiano935]

VERY HELPFUL! Great teaching method. I got to easily understand all the concepts! Thank you!

[@Aurora-oe2du]

Very helpful, thank you!

[@doctorsvlog8822]

Loved the way u taught 😍

[@meghanpritchard7520]

Thank you so much!!

[@carisamclean6716]

This is amazing Dr. Rahul. I did not understand the role of aldosterone until now.

[@maryr8622]

Thank you!!!! 😊

[@patelyoboat]

This was so helpful & engaging. Love your energy!

[@Sam_1964]

Outstanding presentation

[@rachnaprasad4579]

Hi, I have a doubt, at around 31:00, following which segment of nephron has lowest conc of inulin, why is the answer not the thick ascending loop of henle? Isn't that the most hypoosmotic region of the nephron? Bowman's capsule would be iso-osmotic while this would be hypo- osmotic, wouldn't it?

[@drhousemd3359]

Awesome lecture Rahul..learned so many important concepts..love from Pakistan ❤️

[@cynthiarui2003]

Fantastic! Congratulations... I like your lectures...

[@didiervielot2917]

you are a great teacher!!!!!!

[@LinGar_7]

This is AMAZING!!! THANKS A MILLION!!!

[@JustinMoreira]

This is amazing man. Keep it up!

[@annkuruga7063]

👏👏

[@abby6713]

would you say his videos are good comprehensive review of what will be covered on the Physiology NBME? If you have taken it (lol).

[@JustinMoreira]

@@abby6713 watch his review video while going through that system in first aid to pick up what he doesn’t cover. But keep in mind his videos are high yield review so you’re more likely to see these sort of questions. Helped me tremendously. Good luck and thank you Rahul!

[@MesayGashu]

Amazinggg

[@idlisambharisme]

so helpful and pumped in with the session

[@abby6713]

would you say his videos are good comprehensive review of what will be covered on the Physiology NBME? If you have taken it (lol).

[@harveenkaur1713]

super helpful! thank you!!

[@abby6713]

would you say his videos are good comprehensive review of what will be covered on the Physiology NBME? If you have taken it (lol).

[@abhishekchatterjee7184]

This is helpful for all future Doctors.

[@raymondngene1413]

.very impressive. Its rich and wonderful

[@kklots14]

U r amazing 👏

[@lethabomasenya9278]

Dr Rahul, thank you so much for your dedication and time to help us learn! Your passion!!! 🙌🏽🙌🏽🙌🏽 The confusion I have is based on the question you asked : which portion of the nephron is hyperosmotic? Would it be incorrect to say that it is the PCT, with reference to the cortical nephron (which is the most dominant nephron type) - because as we know, when we speak of the cortical nephron, the PCT lies in the cortex.

[@hyguruprep]

Great question! Typically the contents within the lumen of the PCT are isoosmotic. As you have tubular reabsorption of water in the descending LoH, you increase the osm (hyperosmolar) at the hair-pin loop of the LoH. Subsequently you have ascending LoH reabsorption of solutes and subsequent decline in osmolarity in the DCT. Hope this helps!

[@lethabomasenya9278]

Okay perfect! Thank you… This makes sense. 🙌🏽

[@Jhwright07]

Phenomenal!

[@Goljian]

Thank you! Super 👍

[@mario97br]

Yes yes

[@lord-mf2sf]

This was a very fucking important session.. Thank you sir❤️❤️❤️

[@aishafida4517]

Does it include whole renal physio portion of first aid?

[@hyguruprep]

@@serenapasciaa9157 This is spam.

[@TheRebellefleur27]

Wow, will you marry me? I just watched this before my NBME and I jut have to say thank you so much. I am on your website now hoping to be able to order the course for the rest of them. Thank you eternally. God bless.

[@hyguruprep]

Best comment ever! Thanks so much! I hope it was helpful. Best wishes studying!

[@humma91]

Wooh wooh!

[@gulzehra6504]

Nephron

[@gulzehra6504]

Cortical

[@DoctorsDairy]

India

[@serenapasciaa9157]

WhatsApp/Call/Text [phone] Email : [e-mail] Greetings, please this goes to all the nursing students preparing for the upcoming NBDE NCLEX USMLE OET USML Exams from any board of choose in USA, CANADA if you have registered and got your(ATT), and have been scheduled for test date, worry no more just contact us for support and guidance,we help provide some basic materials and review. Please take note getting you preparation materials takes just some higher authorities to succeed and this service is available now due to the covid 19 pandemic . Interested clients/students should contact me via WhatsApp/Call/Text [phone] Email : [e-mail] for more counselling and fast preparation towards their exams.if you are preparing for the OET or USML exam you can contact

[@mukeshjoshi5302]

Moscow

[@malamati007]

First 7 minutes totally wasted time--skip those and get to the beginning of the substantive talk at 7:30.

[@hyguruprep]

hey! just wanted to give a little background before I started, thanks for your time stamp.

[@serenapasciaa9157]

WhatsApp/Call/Text [phone] Email : [e-mail] Greetings, please this goes to all the nursing students preparing for the upcoming NBDE NCLEX USMLE OET USML Exams from any board of choose in USA, CANADA if you have registered and got your(ATT), and have been scheduled for test date, worry no more just contact us for support and guidance,we help provide some basic materials and review. Please take note getting you preparation materials takes just some higher authorities to succeed and this service is available now due to the covid 19 pandemic . Interested clients/students should contact me via WhatsApp/Call/Text [phone] Email : [e-mail] for more counselling and fast preparation towards their exams.if you are preparing for the OET or USML exam you can contact

[@kirsten9729]

@@hyguruprep The whole video was helpful for me! Maybe you can put time markers in the description box for these people who only want specific info (:

[@raymondngene1413]

This a hyper stuffed and interesting lecture. Keep it up sir.