We encountered a case of elastosis perforans serpiginosa in a patient with coexisting renal disease, the first such reported association of which we are aware. The perforating disorders tend to have atypical clinical features when associated with renal disease. The exact pathogenic mechanism by which renal disease predisposes to a perforating disease remains to be elucidated but is likely to be related to minor trauma, which occurs in renal disease.