Abstract-The renin-angiotensin system is a well-known regulator of blood pressure and plays an important role in the pathogenesis of cardiovascular disease and renal damage. Genetic factors, including single nucleotide polymorphisms and sex, are increasingly recognized as potential risk factors for the development of cardiovascular disease. Double transgenic rats (dTGRs), harboring human renin and angiotensinogen genes, were used in this study to investigate potential sex differences influencing renal function and renal gene expression. dTGR males and females had comparable increases in blood pressure, whereas body weight, albuminuria/proteinuria, and urine flow rate were higher in males. At 8 weeks of age, renal plasma flow and glomerular filtration rate were proportionally lower in males, and renal vascular resistance tended to be higher. Males developed more severe tubulointerstitial and vascular lesions. By the end of week 8, 40% of the males but none of the females had died. Genome expression studies were performed with RNA from kidneys of 7-week-old male and female dTGRs and control rats to further investigate the sex-related differences on a molecular level. Forty-five genes showed sex-dependent expression patterns in dTGRs that were significantly different compared to controls. Cathepsin L, one of the genes differentially expressed between the sexes, was also shown to be strongly associated with the degree of renal injury. In dTGRs, urinary cathepsin L at week 7 was higher in males (nanograms per 24 hours: male, 512Ϯ163; female, 132Ϯ70). These results reveal a potential new biomarker for the personalized diagnosis and management of chronic kidney disease. Key Words: sex difference Ⅲ renin-angiotensin system Ⅲ double transgenic rats Ⅲ hypertension Ⅲ renal disease Ⅲ oxidative stress Ⅲ gene expression I n developed countries, the life expectancy of men is usually shorter than that of women. 1 Men tend to have higher blood pressure than do premenopausal women of similar age, 2,3 and this difference is associated with a greater risk for the development of cardiovascular disease and renal damage. End-stage renal disease is indeed more frequent in men than in women, 4 and the rate of progression of chronic renal disease is generally more rapid in men. 5,6 There is ample evidence to suggest an involvement of the renin-angiotensin system (RAS) in blood pressure increase and kidney failure. 7,8 An impact of sex has also been reported in experimental animal models of renal disease and hypertension, including a rat model of mild chronic inhibition of NO synthesis, 9 spontaneously hypertensive rats, 10 deoxycorticosterone acetate-salt rats, 11 Dahl salt-sensitive rats, 12 and the Goldblatt 2-kidney, 1-clip rats. 13 Because, in these models, the sexrelated differences in the development of hypertension and renal damage were associated with the RAS, the double transgenic rat (dTGR), expressing both human renin and angiotensinogen genes, provides an ideal model to explore sex-dependent responses to RAS dysregulation.S...