There is a pressing need to find effective strategies for the prevention of contrast induced nephropathy in patients with advanced renal dysfunction. The current study was designed to assess the efficacy of a new protocol for preventing contrast induced nephropathy in patients with advanced renal dysfunction undergoing coronary interventions

Inclusion Criteria:

Patients with estimated glomerular filtration rate<45ml/min undergoing coronary angiography due to one of the following indications in accordance with the 2014 guidelines:

1. Elective coronary angiography due to symptoms suggestive for angina with a positive non-invasive ischemia assessment of ≥10% of left ventricle.
2. Non ST-elevation acute coronary syndrome with a GRACE score>110

Exclusion Criteria:

• Patients on dialysis or those planned for dialysis in the next 3 months.
• Patients with ST-elevation myocardial infarction
• No symptoms or signs of heart failure
• Treatment with IV diuretics during the 48 hours prior to enrolment
• Patients with acute renal failure (Creatinine raise of at least 0.3mg/dl from )baseline
• Patients post coronary artery bypass surgery