Contrast-induced nephropathy related to cardiac and peripheral vascular procedures is a major problem in the United States and abroad. Measures to prevent and treat this complication have been hampered by the lack of clinical tools to detect acute kidney injury following contrast administration. Emerging novel serum and urinary biomarkers may provide sensitive detection of early kidney injury prior to creatinine elevation and allow for more precise risk stratification and management of patients. This article discusses the biologic and clinical data supporting the development and utility of several promising biomarkers in the management of patients undergoing cardiac catheterization and percutaneous coronary intervention.