Abstract: Case presentation: A 16-year-old Australian Indigenous female at 23 weeks of pregnancy (gravida 1, para 0) presented to the emergency department after 3–4 days of fatigue, vomiting and dark-coloured urine. Aside from multiple skin sores present for some months prior, systemic review was unrevealing. She had no previous medical history. Kidney function tests were normal 6 months earlier. There was a maternal history of rheumatic heart disease but none of kidney disease. The patient had received limited antenatal care. She denied smoking or alcohol use. Her only regular medications were multivitamins and iron.