Because stage and grade of renal cell carcinoma (RCC) sometimes fail to predict the patient's outcome, additional prognostic predictors are needed. Apoptosis is a process of programmed cell death seen in both normal and neoplastic tissues, which has been shown to have prognostic significance in some tumor types. Forty-seven RCCs were studied for size, grade, stage, apoptosis, and proliferation. Fragmented DNA, a hallmark of apoptosis, was detected in situ by a process in which the fragmented DNA was labeled with a biotinylated nucleotide, which, in turn, was detected by an avidin-biotin-peroxidase labeling system. The proliferating tumor cells were detected by immunostaining with the MIB-1 antibody. The apoptotic index and proliferation index of each RCC were expressed as the number of tumor cells undergoing apoptosis and proliferation per 1,000 tumor cells. For grade I to IV RCCs, the median proliferative index was 13, 41, 119, and 143; the median apoptotic index was 8, 12, 39, and 73. For stage I to IV RCCs, the median proliferative index was 21, 34, 70, and 144; the median apoptotic index was 8, 9, 20, and 69. There was a statistically significant correlation of tumor grade, stage, and size with both proliferative index and apoptotic index. There was a statistically significant correlation between proliferation index and apoptotic index. In conclusion, apoptosis can be easily and reliably recognized by the in situ end labeling of fragmented DNA and may help predict the outcome of RCC.