Contrast induced nephropathy (CIN) is a well-known and serious complication in patients with chronic renal insufficiency undergoing coronary angiography or interventions. CIN is associated with significant morbidity and mortality. This complication results in prolonged hospital stay and substantially increases the cost of medical care. Various therapeutic measures have been evaluated for the prevention of CIN. Peri-procedural saline hydration, use of low osmolality contrast agents and limiting the amount of contrast administered are the preferred methods. In recent years, the efficacy of prophylactic hemofiltration and several pharmacological agents, including low dose dopamine, theophylline, Nacetylcysteine, and fenoldopam have been evaluated in randomized controlled trials. Conflicting results, rather than convincing conclusions, were observed in the studies of most of these agents. Meta-analysis suggested that the use of Nacetylcysteine and theophylline may be able to prevent the decline of renal function after contrast exposure. This review provides an update on the recent studies in this subject as well as a critical analysis on how available evidence could be translated to daily clinical practice.