Skin manifestations of chronic kidney disease (CKD) are commonly encountered and can be due to (1) the cause of the underlying renal disease, either acquired or heritable; (2) conditions unique to uremia; or (3) immunosuppressive therapies and/or immunosuppression itself in renal transplant recipients.

Diabetes and hypertension account for most cases of end-stage renal disease (ESRD) in the United States; however, many diseases, such as amyloidosis, connective tissue diseases, hepatitis C and B viral infections, and numerous genetic diseases may also cause ESRD. These conditions often possess characteristic cutaneous findings, which may be the first clue to an underlying kidney disease.

Skin findings such as alopecia, nail changes, pigmentary alteration, pruritus, and xerosis are not specific to uremia per se, but are frequently observed in patients with impaired renal function and impact quality of life.

Calciphylaxis is a rare but severe syndrome with high morbidity and mortality that involves calcium deposition in small vessels within the dermis and subcutaneous tissue, leading to exquisitely tender, retiform purpuric plaques that frequently ulcerate.

Acquired perforating dermatoses represent a spectrum of disorders with transepidermal elimination of material from the dermis with little damage to surrounding tissue, clinically presenting as keratotic lesions most commonly on the trunk and extremities.

Nephrogenic systemic fibrosis is characterized by thickened collagen in the skin and other organs, hyperpigmented, brawny plaques and papules most frequently starting on the extremities, and an association with exposure to gadolinium-based contrast agents in patients with renal compromise.

Bullous diseases in CKD include porphyria cutanea tarda (PCT), pseudoporphyria, and bullous disease of dialysis.

Renal transplant recipients are at risk for medication-related cutaneous changes, infections, and cutaneous malignancies secondary to immunosuppression.