Background: Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures and results from administration of iodinated contrast media (CM). Aim: was to study the preventive and the therapeutic effects of Mineralocorticoid receptor antagonist’s pretreatment on contrast-induced acute kidney injury in patients undergoing coronary angioplasty. Methods: This case control study was carried out on patients admitted for coronary angioplasty in Benha University Hospitals(cardiology department), in which 100 patients were selected and divided in two groups “active &control” Group (A)(control): received placebo. Group (B) (Active): received Spironolactone 50 mg. Results: Blood Urea in Group (A) showed a significant increase during follow up when it was compared to baseline values while in Group (B) it showed an increase during follow up but without any statistically significant difference. Serum Creatinine in Group (A) showed a significant increase after 2 days of follow up with a mean value of 1.30±0.248 when it was compared to baseline values while in Group (B) it showed a significant increase after 2 days of follow up with a mean value of 1.15±0.406when it was compared to baseline values and also when compared to values after 7 days of follow up with a mean value of 1.19±0.384. Conclusion: The administering of Mineralocorticoid therapy prior to coronary angioplasty obtains additional benefit in terms of decrease incidence of CI-AKI in CAD patients.