Diagnosis of acute kidney injury (AKI) in pregnancy is complicated by haemodynamic and urinary tract changes in pregnancy, and non-pregnant references intervals for serum creatinine should not be used. Pre-eclampsia is the most common cause of AKI in pregnancy. Although pregnancy-associated haemolytic mircoangiopathies are rare, it is useful for physicians and nephrologists to be aware of potential clinical discriminators.Pregnancy is successful for most women with chronic kidney disease (CKD). There is, however, an increased risk of adverse maternal and neonatal outcomes at all stages of CKD, including pre-eclampsia, growth restriction, preterm delivery, low birthweight, neonatal unit admission and postpartum loss of maternal renal function.