Examination of the skin and nails can reveal many abnormalities in patients with end-stage renal disease that precede or follow initiation of dialysis treatment or kidney transplantation. This article focuses on specific and nonspecific cutaneous signs of end-stage renal disease, reviewing both banal and life-threatening conditions, including pruritus, perforating disorders, calcifying disorders, and bullous dermatoses. The pathogenesis, clinical findings, histologic findings, differential diagnosis, and treatment of these diseases are discussed. Cutaneous manifestations unique to kidney transplantation will not be covered. (J Am Acad Dermatol 2000;43:975-86.) Learning Objective: After the completion of this learning activity, participants should be familiar with cutaneous manifestations of end-stage renal disease including pruritus, perforating disorders, calcifying disorders, and bullous dermatoses.