A 28-year-old woman in her third pregnancy presented at 13 weeks’ gestation with low-grade fever, progressive fatigue, asthenia, and gross hematuria of 1 week’s duration. Her medical history included coarctation of the aorta, corrected with stent implantation, and chronic sinusitis. Home medications included aspirin 100 mg daily, amlodipine 10 mg daily, and bisoprolol 5 mg daily. She had no history of kidney disease, and had a baseline serum creatinine of 0.67 mg/dL (estimated glomerular filtration rate of 104 mL/min/1.73 m2) 1 month prior.