Renal anatomy and physiology are significantly affected by pregnancy, with changes to kidney size as well as glomerular and tubular function. Any potential interstitial, vascular, or glomerular cause of renal insufficiency and/or proteinuria can present or worsen during pregnancy. Due to the pregnancy-associated dilatation of the urinary tract, asymptomatic bacteriuria can progress to cystitis and/or pyelonephritis, along with more severe maternal complications such as septicemia and renal insufficiency, if not promptly treated. Pre-eclampsia, the most common cause of the constellation of renal insufficiency, hypertension and proteinuria, is essentially a disease of the placenta. Acute kindney injury, if severe enough, may require renal replacement therapy irrespective of the etiology. Indications for dialysis are no different in pregnancy and include imbalances in electrolytes and volume status that cannot be managed medically. Drugs typically given to dialysis patients, including erythropoietin stimulating agents and heparin, are safe.