Hypoxia inducible factor (HIF) prolyl-4-hydroxylase domain-containing proteins (PHDs) promote the degradation of HIF-1␣. Because HIF-1␣ is highly expressed in the renal medulla and HIF-1␣-targeted genes such as nitric oxide synthase, cyclooxygenase, and heme oxygenase are important in the regulation of renal medullary function, we hypothesized that PHD regulates HIF-1␣ levels in the renal medulla and, thereby, participates in the control of renal Na ϩ excretion. Using real-time RT-PCR, Western blot, and immunohistochemical analyses, we have demonstrated that all three isoforms of PHD, PHD1, PHD2, and PHD3, are expressed in the kidneys and that PHD2 is the most abundant isoform. Regionally, all PHDs exhibited much higher levels in renal medulla than cortex. A furosemide-induced increase in renal medullary tissue PO2 significantly decreased PHD levels in renal medulla, whereas hypoxia significantly increased mRNA levels of PHDs in cultured renal medullary interstitial cells, indicating that O2 regulates PHDs. Functionally, the PHD inhibitor L-mimosine (L-Mim, 50 mg ⅐ kg Ϫ1 ⅐ day Ϫ1 ip for 2 wk) substantially upregulated HIF-1␣ expression in the kidneys, especially in the renal medulla, and remarkably enhanced (by Ͼ80%) the natriuretic response to renal perfusion pressure in Sprague-Dawley rats. Inhibition of HIF transcriptional activity by renal medullary transfection of HIF-1␣ decoy oligodeoxynucleotides attenuated L-Mim-induced enhancement of pressure natriuresis, which confirmed that HIF-1␣ mediated the effect of L-Mim. These results indicate that highly expressed PHDs in the renal medulla make an important contribution to the control of renal Na ϩ excretion through regulation of HIF-1␣ and its targeted genes. fluid homeostasis; anoxia; natriuretic factor; gene transcription; renal tubules; renal hemodynamics IT IS WELL KNOWN that PO 2 is much lower in the renal medulla than in the renal cortex because of relative "underperfusion," the countercurrent O 2 diffusion between descending and ascending vasa recta, and the high metabolic ion transport activity of the thick ascending limb of Henle in the renal medullary region (6, 10). To adapt to this low-PO 2 milieu, the renal medulla has naturally developed various mechanisms to protect the cells from ischemic and hypoxic injury (5,6,15) and to ensure that the cells in this kidney region function normally in a hypoxic environment (6, 10). Increase in tissue blood perfusion to facilitate the O 2 supply and inhibition of tubular metabolic activity to decrease O 2 demands (5,6,15,53) are the common outcomes of various adaptive actions induced by different renal medullary factors such as nitric oxide (NO), prostaglandins, and heme oxygenase (HO) products. Hypoxia inducible factor (HIF)-1␣, the master regulator of adaptation to hypoxia, has been shown to activate gene transcription of many O 2 -sensitive genes such as NO synthase (NOS), cyclooxygenase (COX), HO, and vascular endothelial growth factor (21,25,26,32,38,45,50,53). The participation of the products controlled...