Ischemia-reperfusion (IR) injury is the most common cause of AKI. The susceptibility to develop AKI varies widely among patients. However, little is known about the genes involved. 20-Hydroxyeicosatetraenoic acid (20-HETE) has an important role in the regulation of renal tubular and vascular function and has been implicated in IR injury. In this study, we examined whether a deficiency in the renal formation of 20-HETE enhances the susceptibility of Dahl salt-sensitive (SS) rats to ischemic AKI. Transfer of chromosome 5 containing the CYP4A genes responsible for the formation of 20-HETE from the Brown Norway (BN) rat onto the SS genetic background increased renal 20-HETE levels after ischemia and reduced plasma creatinine levels (6SEM) 24 hours after IR from 3.760.1 to 2.060.2 mg/dl in an SS.5 BN -consomic strain.Transfer of this chromosome also prevented the secondary decline in medullary blood flow and ischemia that develops 2 hours after IR in the susceptible SS strain. Blockade of the synthesis of 20-HETE with HET0016 reversed the renoprotective effects in SS.5 BN rats. Similar results were observed in an SS.5 Lewcongenic strain, in which a smaller region of chromosome 5 containing the CYP4A genes from a Lewis rat was introgressed onto the SS genetic background. These results indicate that 20-HETE has a protective role in renal IR injury by maintaining medullary blood flow and that a genetic deficiency in the formation of 20-HETE increases the susceptibility of SS rats to ischemic AKI. AKI is a common condition that is associated with significant mortality. 1 The incidence of AKI has increased by 10% per year over the last decade, and the mortality rate has more than doubled. 2 Renal ischemia-reperfusion (IR) injury is the most frequent cause of AKI, and the incidence of AKI exceeds 50% after major cardiac, aortic, or transplant surgery. 3,4 Unfortunately, there is no approved therapy for the treatment of AKI. 5 The susceptibility to develop AKI also varies widely among patients 6 and among different strains of rats. In this regard, Basile et al. 7,8 previously reported that Brown Norway (BN) rats are more resistant to the development of IR injury than Sprague-Dawley or Dahl salt-sensitive (SS) rats.More recently, transfer of the X chromosome and chromosomes 3-8, 10, and 15 from BN rats has been reported to confer partial protection to renal IR injury in consomic strains of SS rats. 8 However, little is known about the genes or mechanisms involved. Previous studies have indicated that 20-hydroxyeicosatetraenoic acid (20-HETE) plays an important role in the regulation of renal tubular and vascular