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1. Identify uremic frost from visual cues. 2. Describe the mechanism for development of uremic frost and appropriate management. Uremic frost is a rare manifestation of end stage renal disease that is sometimes seen at the end of life. Identification of this condition is essential in providing appropriate counseling to patients and their families. An 85 y/o M with a PMH of CHF, atrial fibrillation, pacemaker placement, CAD, aortic valve regurgitation, hypertension, presented to our academic medical center with a chief complaint of impaired responsiveness. He was later found to have impaired mentation and left hemiparesis. His CAT scan showed an MCA territory hypodensity. A family meeting was held between the patient's 2 daughters and the primary team and recommendations were made for hospice care. The patient was transferred to the inpatient hospice unit for management of delirium. On arrival, the patient's PPS was 10%. He was awake, alert, oriented x0. He was dependent in all ADLs and taking in no nutrition. His exam revealed white crystallization on his head and face. The patient's family worried about development of this new rash. This was identified as uremic frost a dermatologic manifestation of ESRD with urate crystals developing on the skin of patient's with impending renal failure. In patient's with restorative goals, renal replacement therapy and treatment of underlying uremia is essential. In patients like ours, management is focused on comfort and reassurance. Our presentation will include further description of uremic frost as well as de-identified photos of our patient (with the permission of their family) to help teach how uremic frost develops. Disease specific management, Managing Suffering and Distress [ABSTRACT FROM AUTHOR]