1. Fenoldopam is a dopamine-like receptor agonist that selectively increases renal medullary blood flow. Despite promising pathophysiology, randomized controlled trials have failed to show a benefit with intravenous infusion of fenoldopam in preventing contrast-induced nephropathy (CIN). 2. The aims of the present study were to examine the efficacy of intrarenal (i.r.) fenoldopam in preventing CIN in high-risk patients undergoing coronary angiograms and percutaneous revascularization. 3. The present study was a single centre, retrospective observational matched cohort study that included 52 patients at risk of developing CIN to whom i.r. fenoldopam was given during catheter-based coronary procedures. For each patient treated, a control patient was identified on basis of an identical Mehran score. Observed rates of CIN and in-hospital dialysis were compared between the i.r. fenoldopam and control groups. 4. Direct comparison of the 52 patients treated with i.r. fenoldopam and the 52 matched controls revealed that the two groups had similar baseline clinical characteristics and creatinine levels (2.4 ± 0.7 vs. 2.2 ± 0.6 mg/dL; P = 0.12). In the i.r. fenoldopam group, six patients (11.5%) developed CIN, compared with 16 patients in the control group (30.8%; risk ratio 0.38; 95% confidence interval 0.16-0.88; P = 0.012). 5. None of the patients in the fenoldopam group needed in-hospital dialysis, compared with three patients in the control group. 6. A larger prospective randomized study is needed to prove the effectiveness of this protective approach.