The kidneys receive ~25% of the cardiac output but weigh ~1% of total body weight. Yet the kidney is susceptible to hypoxia. One mechanism that may contribute to this susceptibility is the countercurrent shunting of oxygen, both in the cortex between arteries and veins and in the medulla between descending and ascending vasa recta. The susceptibility of the kidney, and in particular the renal medulla, to hypoxia may contribute to the pathogenesis of acute kidney injury. The physiology of renal oxygenation is further complicated by the arrangement of the renal circulation. That is, arterial blood destined for the medulla travels with blood destined for the cortex, to the level of the proximal interlobular arteries, where the afferent arterio...