Renal insufficiency is associated with a bleeding tendency. Hemorrhagic manifestations are usually mild (i.e., ecchymoses or purpura) but can be severe in occasional patients who may have gastrointestinal tract or intracranial bleeding. Modern techniques for the management of uremia have definitely reduced the incidence of severe bleeding episodes in patients with renal failure, but hemorrhages still represent a major clinical problem, particularly for patients undergoing surgery or invasive procedures. Although the pathogenesis of uremic bleeding has not been completely elucidated, in the past 10 years a number of studies have contributed substantially to our knowledge of the cause of uremic bleeding tendency and have indicated new therapeutic strategies. The present review will focus mainly on modern concepts of the cause of uremic bleeding and will critically analyze the various therapeutic approaches.