The incidence of pre-eclampsia is high in women with chronic kidney disease and hypertension and the diagnosis is particularly challenging. Bramham et al. (2016) studied various biomarkers with the primary aim of predicting superimposed pre-eclampsia requiring delivery within 14 days of sampling. Their findings of the utility of a single biomarker for diagnosis in this high-risk group is a major advance that has significant implications and holds promise for the future.