In recent years the number of patients with chronic renal insufficiency has grown steadily. As these patients have a high risk for cardiovascular diseases, they often require examination using contrast medium-enhanced radiologic procedures. This article reviews iodinated and gadolinium contrast medium-induced side effects, which are specific for patients with high-grade renal insufficiency. In particular the prevalence, clinical symptoms, pathomechanisms, risk factors and preventive measures for contrast medium-induced nephropathy and nephrogenic systemic fibrosis are discussed.