Nephrological reviews are usually accolades to progress in the field. Advances pertaining to renal structure and function, techniques to study them, and understanding renal disease and its treatment by dialysis and transplantation are examples. Unfortunately, the area of nephrology which relates to pregnancy has not advanced similarly and when clinicians are asked to advise whether or not women with kidney disease, a renal transplant or a history of previous pregnancies marred by severe hypertension, should conceive or if pregnant continue the gestation, it becomes obvious that data are scarce and opinions vary. This neglect is unfortunate as renal and hypertensive complications of pregnancy remain an important cause of morbidity and mortality in mother and fetus. This review focuses on (a) the renal changes which occur during normal pregnancy, stressing the relevance to clinical practice; (b) controversies surrounding some of the urinary tract problems encountered in pregnancy; (c) detection and management of chronic renal disease and the effect of pregnancy 'on remote prognosis; (d) the kidney in pre-eclampsia; (e) pregnancy in renal transplant and haemodialysis patients; and (f) acute renal failure in obstetric practice.