In 1997, a new fibrosing skin disorder became apparent among patients with renal disease. Nephrogenic systemic fibrosis, as this disorder has come to be known, has recently been tied to the administration of contrast agents containing gadolinium. This overview examines the discovery and elucidation of the major research accomplishments to date. It was presented as the keynote address at the First Annual Scientific Symposium on Nephrogenic Systemic Fibrosis and MRI Contrast, conducted at Yale University on May 4, 2007.