Nitric oxide synthase has been identified in several epithelial cells in the kidney, including proximal tubular cells, thick ascending limb, inner medullary collecting duct, and interstitial cells. Nitric oxide (NO) plays an important role in renal hemodynamics and sodium tubular transport. We have demonstrated that NO participates in hypoxia/reoxygenation (H/R) injury in isolated rat proximal tubules (PT) suspensions. In this in vitro model L-arginine addition enhanced H/R injury while L-NAME almost completely prevented injury. These effects were less intense in chronic supplemented rats with L-arginine and L-NAME, suggesting that NO synthase manipulation had interfered with PT susceptibility to H/R injury. In contrast, L-arginine protected IMCD cells in culture from hypercholesterolemic rats against hypoxia. Moreover, acute infusion of L-arginine before bilateral renal artery clamping was protective while L-arginine chronic administration and L-NAME were deleterious in this ARF model. The L-arginine protection was not observed in unilateral renal clamping plus contralateral nephrectomy in normal rats, but L-arginine was protective in hypercholesterolemic rats. Taken together, these results suggest that the net effect of NO stimulation is variable, and that it is the result of a balance between beneficial hemodynamic effects and cytotoxicity.