Pregnancy in insufficiency renal and dialysispatients is a challenging situation. Since its first description in 1971, a growing number of cases have been described with conflicting information about maternal and fetal outcome. The main obstetrical adverse outcomes on the management of these patients are arterial hypertension, polihydramnios, intrauterine growth restriction and prematurity. The neonatal complications are consequences of prematurity and include pneumothorax, respiratory distress syndrome, sepsis, necrotizing entercolitis, chronic lung disease, intraventricular hemorrhage and deafness. This article aims to review the literature presenting the outcome of the most recent maternal and perinatal outcomes, discussing the controversies in the treatment of these patients and presenting the main steps in prenatal care as well as during labor.