No organ in the chest is spared the negative effects of uremia. The dialytic treatment itself is often associated with a large array of thoracic complications. We review the main thoracic manifestations of the terminal uremia from the radiological point of view, such as: uremic pleuritis and pericarditis, uremic pneumonia, renal osteodystrophy, infections, and metastatic pulmonary calcifications. Respiratory function derangement and the problems related to peritoneal dialysis and hemodialysis are discussed in some detail, along with the diagnostic role of plain films, US, nuclear medicine, and CT. The main focus of this review is on the hydration problems and pulmonary edema, often related to a large number of pathogenetic factors. Based on our experience, we think that the chest X-ray is not able to accurately discriminate between cardiogenic edema and fluid overload edema (so-called renal pulmonary edema). The radiological findings of the thoracic complications in uremic patients are multiple and complex but, in most cases, the imaging techniques may offer an accurate and noninvasive diagnostic approach, with a high benefit-cost ratio.