The expanding use of imaging and interventional studies with iodinated radiologic contrast agents underscores the potential risk for dye nephropathy. Currently, dye-induced nephropathy is one of the leading causes of iatrogenic acute kidney failure, accounting for about 10% of renal failure in intensive care units. In this review, the pathophysiology of radiocontrast nephropathy is discussed, with a special emphasis on the importance of medullary hypoxic damage. The risk factors and clinical course of dye nephropathy, as well as its prevention or potential therapeutic interventions, are discussed in this perspective.