Chronic renal failure (CRF) during pregnancy increases the risk of fetomaternal complications such as preeclampsia, premature delivery and, above all, a deterioration of renal function. A multidisciplinary preconceptional assessment is necessary in this complex clinical situation. Progress in neonatal resuscitation and a better understanding of the pathophysiological mechanisms of autoimmune nephropathy have improved the prognosis of these high-risk pregnancies. This article provides an overview of the issues related to the follow-up of pregnant women with renal disease. It summarizes the glomerular and hemodynamic physiological changes during pregnancy, the fetal and maternal risk, and the adaptation of antihypertensive and immunosuppressive drug treatments.