Apoptotic pathways in ischemic acute renal failure. The study of cell death has emerged as an important and exciting area of research in cell biology. Although two kinds of cell death, apoptosis and necrosis, are recognized, one of the major advances in our understanding of cell death has been the recognition that the pathways traditionally associated with apoptosis may be very critical in the form of cell injury associated with necrosis. Renal tubular epithelial cell injury from ischemia has been generally regarded as a result of necrotic form of cell death. We briefly describe recent evidence indicating that pathways generally associated with apoptosis, including endonuclease activation, role of mitochondria and caspases, are important in renal tubular injury. It is likely that the cascades that lead to apoptotic or necrotic mode of cell death are activated almost simultaneously and may share some common pathways.