KEYWORDS kidney transplant pregnancy preeclampsia TOPICS Medicine ABSTRACT Pregnancy after kidney transplantation carries a high risk of hypertensive disorders, particularly preeclampsia with severe features, which remains a major contributor to maternal and perinatal morbidity. Diagnostic complexity arises from overlap between preeclampsia findings and chronic kidney disease or graft dysfunction. This case report presents a rapidly progressive form of preeclampsia superimposed on impaired allograft function, underscoring limited therapeutic options and the need for vigilant assessment. The clinical course highlights the importance of preconception counseling, adherence to immunosuppressive therapy, and strict blood pressure control. It also emphasizes the role of multidisciplinary management and timely identification of maternal and foetal deterioration. The presented case illustrates key risks and complications encountered in clinical practice.