Because of the well-documented risk of acute renal failure with the iodinated contrast media in patients with underlying chronic renal insufficiency, the use of intravenous gadolinium-based contrast media in magnetic resonance imaging for diagnostic and interventional radiology procedures has become a well-established clinical practice in the recent years. Although originally thought to be safe and lack the nephrotoxic effects of iodinated contrast media, gadolinium-based contrast media have recently been reported to induce a usually reversible decrease of glomerular filtration rate in a high-risk population group, especially in patients with altered baseline renal function. Here we present the current experimental and clinical evidence on this new challenge for the nephrologist, gadolinium-induced nephrotoxicity in patients with chronic kidney disease.