Determinants of serum uric acid (SUA) levels in relation to kidney function have not been extensively studied in elderly Japanese people. In this cross-sectional study, relationships of SUA with anthropometric indices, serum adipokines and liver enzymes, insulin-resistance related variables and inflammatory markers in relation to kidney function were examined in 159 community-dwelling elderly Japanese women. By simple linear regression analysis, serum creatinine and cystatin C were positively and eGFR was inversely associated with SUA. It was also positively associated with BMI, percentage body fat, serum leptin and transthyretin. In addition, SUA showed positive associations with fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and serum gamma-glutamyltransferase (GGT). Further, log high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor-alpha (TNF-α) were associated with SUA. Multiple regression analysis with SUA as a dependent variable showed that 27% of the variability of SUA can be accounted for by serum creatinine, GGT, leptin and transthyretin in order of increasing R2. In elderly Japanese non-obese women, high serum uric acid levels may represent a more favorable nutritional status and increased body fat in addition to poorer renal function. Associations with serum creatinine and GGT warrant further study.