Nephrogenic fibrosing dermopathy is a relatively new skin disorder affecting only individuals with renal failure. This disease resembles scleromyxedema with thickening and hardening of the skin of the extremities, but it is distinctly different. Nephrogenic fibrosing dermopathy has no consistently effective treatment and its cause is unknown; however, there are several documented theories as to the factors that may contribute to its development. We present a brief overview of the literature and four patients with the disorder who share similarities in disease onset.