A 27-year-old white woman pregnant with her first child was found to have blood pressure of 180/120mmHg at 23 weeks’ gestation. Her medical history was notable for recurrent urinary tract infections since childhood and an episode of pyelonephritis at 20 years old. A single episode of macroscopic hematuria occurred at 5 weeks’ gestation, when urinalysis revealed proteinuria. At that time, physical examination showed that she was euvolemic and had blood pressure of 140/80mmHg. There was no evidence of right upper quadrant tenderness, clonus, rash, arthropathy, or papilledema.