Contrast nephropathy after coronary angiography is associated with considerable morbidity and mortality. We discuss the incidence, definition, and pathologic mechanisms of contrast nephropathy; provide an overview of risk factors; highlight proven preventive interventions; clarify which interventions have shown no benefit; and discuss future possibilities. The prevention of contrast nephropathy is crucial for the care of patients undergoing coronary angiography and should be possible with an understanding of risk factors and proven management strategies.