L-type Ca2+ channel blockers (CCBs) have been shown to be protective against ischemia-induced injury of the kidney, suggesting that increased intracellular Ca2+ levels ([Ca2+]i) play an important role in the pathogenesis of ischemic cell injury. To assess the role of [Ca2+]i in anoxic injury of the proximal tubule (PT) and the protective effect of CCBs, digital imaging fluorescence microscopy was used to monitor [Ca2+]i in individual PT cells during 60 minutes of anoxia. [Ca2+]i started to rise within 10 minutes and reached maximal levels between 30 to 45 minutes of anoxia. The onset of this increase and the maximal levels reached varied markedly among individual cells. The mean values for initial and maximal anoxic [Ca2+]i were 109 +/- 2 (N = 209) and 422 +/- 14 (N = 240) nM, respectively. Methoxyverapamil (D600; 1 microM) significantly reduced anoxic [Ca2+]i to 122 +/- 5 nM (P < 0.05; N = 79). Removal of extracellular Ca2+ completely abolished anoxia-induced increases in [Ca2+]i, confirming that these increases in [Ca2+]i result from Ca2+ influx. During 60 minutes of anoxia, PT cells showed a gradual decrease in cell viability to 54 +/- 2%. D600 (1 microM) significantly increased cell viability to 64 +/- 3% (P < 0.05). Glycine (5 mM), however, increased cell viability to 77 +/- 4% without a significant reduction in anoxic [Ca2+]i levels. Low Ca2+ medium only protected when 0.1 mM La3+ was included, a condition which increased cell viability to 82 +/- 5%.(ABSTRACT TRUNCATED AT 250 WORDS)