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Background: Teaching renal physiology is problematic in many medical schools since conventional passive learning might not be effective. Active learnings including flipped classroom (FC) have been introduced to medical education including renal physiology topic recently, but no study regarding long-term outcomes has been reported., Approach: Two classes of second-year medical students were compared. The former class studied with conventional lecture and the latter class studied with FC. Our FC includes asynchronous instructor-made recorded lectures that students can study according to their pace and available time, followed by synchronous case discussions related to the lecture topic. There were post-test quizzes for all recorded lectures along with the given explanation of the answers after finishing each quiz. Short-term topic understanding and long-term knowledge retention assessed with summative examination and end-of-preclerkship comprehensive examination, respectively, were compared. Attitude towards FC was also assessed., Evaluation: Students in the FC group performed better in both summative examination (70.1 ± 8.9 vs. 62.8 ± 9.9, p < 0.001, a total score of 90) and comprehensive examination (6.5 ± 2.2 vs. 5.9 ± 1.8, p < 0.001, a total score of 11). Most students agreed that FC should be applied despite the increased stress level and that the post-test quizzes were very helpful. Intriguingly, the multivariate analysis showed that male students performed better than female students for both examinations., Implications: Well-designed FC is a promising and highly effective method in renal physiology teaching. Cautions for the instructor include students' stress and gender differences in academic performance. Well-designed FC is a promising and highly effective method in renal physiology teaching., (© 2025 Association for the Study of Medical Education and John Wiley & Sons Ltd.)