In many cases, acute renal failure (ARF) is the result of proximal tubular cell injury and death and can arise in a variety of clinical situations, especially following renal ischemia and drug or toxicant exposure. Although much research has focused on the cellular events leading to ARF, less emphasis has been placed on the mechanisms of renal cell repair and regeneration, although ARF is reversed in over half of those who acquire it. Studies using in vivo and in vitro models have demonstrated the importance of proliferation, migration, and repair of physiological functions of injured renal proximal tubular cells (RPTC) in the reversal of ARF. Growth factors have been shown to produce migration and proliferation of injured RPTC, although the specific mechanisms through which growth factors promote renal regeneration in vivo are unclear. Recently, interactions between integrins and extracellular matrix proteins such as collagen IV were shown to promote the repair of physiological functions in injured RPTC. Specifically, collagen IV synthesis and deposition following cellular injury restored integrin polarity and promoted repair of mitochondrial function and active Na ϩ transport. Furthermore, exogenous collagen IV, but not collagen I, fibronectin, or laminin, promoted the repair of physiological functions without stimulating proliferation. These findings suggest the importance of establishing and/or maintaining collagen IV-integrin interactions in the stimulation of repair of physiological functions following sublethal cellular injury. Furthermore, the pathway that stimulates repair is distinct from that of proliferation and migration and may be a viable target for pharmacological intervention.Most cases of acute renal failure (ARF) result from renal ischemia, acute drug, or toxicant exposure, affecting up to 5% of all long-term hospital patients. Despite the advent of dialysis and increasing knowledge regarding the causes and effects of ARF, nearly half of those who develop the disease do not survive, a trend that has not changed for several decades (Thadhani et al., 1996;Molitoris et al., 2000). A vast majority of research in the field of ARF has focused on the determination of events and factors that cause renal proximal tubular cell (RPTC) injury and death leading to the development of ARF. Unfortunately, the development of therapeutic strategies that are efficacious in humans with ARF has proven problematic. This suggests that the development of more successful therapies requires approaching the problem from a different vantage point (Molitoris et al., 2000). The regenerative capacity of the kidney is well documented, and more than half of noncritically ill patients who acquire ARF survive (Toback et al., 1993;Abbate and Remuzzi, 1996;Liano and Pascual, 1998). The responses of surviving RPTC are thought to be crucial to the restoration of renal function following ARF. Consequently, understanding RPTC repair and regeneration mechanisms may uncover new therapeutic targets that promote renal recovery an...