Interest has been renewed over the role of uric acid in the pathogenesis of hypertension, endothelial dysfunction and renal dysfunction, which are all features of pre-eclampsia. Uric acid is not a consistent predictive factor for the development of pre-eclampsia but its levels generally increase once the disease manifests, and plasma levels of uric acid approximately correlate with disease severity. Hyperuricemia in pre-eclampsia was once thought to result solely from reduced renal clearance, but levels of uric acid are now also thought to increase through increased uric acid production caused by trophoblast breakdown, cytokine release and ischemia. Uric acid can promote endothelial dysfunction, damage and inflammation, which leads to oxidation. Pre-eclampsia, which is characterized by widespread endothelial dysfunction and inflammation, might be propagated by uric acid through these known in vitro activities. Of note, however, uric acid can also act as a scavenger of oxygen free radicals. Plasma urate measurements are currently used to support the diagnosis of pre-eclampsia during pregnancy. As further studies define the role of uric acid in the development of pre-eclampsia, monitoring levels of this factor may again become essential to the future treatment of pre-eclampsia.