Preeclampsia is a serious complication during pregnancy that includes potentially life-threatening risks to the mother and fetus. It may be challenging to distinguish this from other causes of rapidly escalating hypertension, especially in women with end-stage renal disease, because current diagnostic criteria for preeclampsia cannot be easily applied. We report a woman undergoing hemodialysis who was considered to be preeclamptic when her blood pressure suddenly increased during her 29th week of gestation. At that time, she underwent emergent cesarean section. The presence of a normal-sized placenta with no histological evidence of preeclampsia and retrospective analyses of maternal antiangiogenic biomarkers (soluble fms-like tyrosine kinase-1 and soluble endoglin) that were within normal levels for pregnancy suggest an alternative diagnosis. There is growing evidence that circulating levels of these proteins cause the preeclamptic phenotypes and also are sensitive and specific predictors and markers of this disease, suggesting that measurements of soluble fms-like tyrosine kinase-1 and soluble endoglin be considered in such difficult diagnostic dilemmas as the cause of hypertension in pregnant dialysis patients. Additional studies in this particular group of patients are required.