Objective. To determine renal echo structural features in pregnant women with physiological pregnancy, gestational and chronic hypertension, or obesity. Subject and methods. A comprehensive examination was made in 473 pregnant women aged 18 to 46 years with complicated pregnancy and somatic disease: Group 1 included 166 patients with gestational hypertension; Group 2 comprised 64 with chronic hypertension; Group 3 consisted of 90 pregnant women with obesity. A control group was composed of 153 pregnant women in the same age range with neither clinical manifestations of somatic disease nor its evidence in their history. All the patients were examined in in- and outpatient settings in compliance with the diagnostic standards. Results. Ultrasound changes in the kidneys, such as their enlargement, lower shape index and calicopelvis dilation, may be regarded as biometric predictors for renal structural changes progressing during physiological pregnancy. In chronic hypertension, decreased renal cortical thickness and no dynamic changes in the volume and parameters of the calicopelvic system in the third trimester may be considered as predictors for renal structural changes. In gestational hypertension, there were increases in the thickness of the renal cortex and the diameter of renal calyces and pelvis. Conclusion. The renal functional and structural changes revealed by ultrasound biometry and anthropometric characteristic are statistically significantly interrelated and accounted for kidney remodeling during gestation in healthy women, in obesity, gestational and chronic hypertension.