In normal pregnancy, there is a progressive increase in renal size, maximally 1–2 cm by 26 weeks’ gestation, and 70% of which is contributed by vascular and interstitial fluid compartments. The most striking anatomic change is dilation of the calyces, renal pelvis, and ureters which is more prominent on right side, and by the third trimester, about 80–90 % of women show evidence of hydronephrosis. This chapter covers the systemic hemodynamics, renal hemodynamics, pregnancy in patient with kidney disease, renal biopsy during pregnancy, dialysis in pregnancy, diagnosis of pregnancy, and maternal complications. Menstruation is irregular in patients on dialysis and up to 42% may have amenorrhea and the diagnosis of pregnancy is often delayed.