The use of iodinated contrast agents in medicine is inherently contradictory. They are indispensable in several radiologic and therapeutic procedures but also have potentially harmful effects on patients’health. Contrast media induced nephropathy (CIN, CI-AKI ) is a frequent iatrogenic cause of acute renal failure, particularly in high risk patients with chronic kidney disease and diabetes. The exact pathophysiological mechanisms of CIN remain unclear. Proper preprocedural hydration is currently the only evidence-based preventive strategy. Also, temporary withdrawal of nephrotoxic drugs seems reasonable. Several new biomarkers have emerged over the past decade and have the potential to detect CIN early. This article seeks to provide a contemporary overview of the pathophysiology and diagnosis of this common clinical complication.