Over the last decade, several divergent views have been expressed regarding the effect that iodinated contrast agents may have on renal function. Evidence-based medicine often requires the recommendation of high-performance contrast-enhanced imaging exams for precise positive diagnosis. The fear of intravenous contrast use in patients with elevated serum creatinine seems to become an old dogma, outdated by the benefits of the procedures. Patients with glomerular filtration rate below 30 mL/min/1.73 m2 can be protected by peri-procedural hydration and withdrawal of other nephrotoxics. Whatever the degree of risk, current guidelines recommend contrast-enhanced investigations in any situations where the advantages for the diagnosis are certain.