Introduction: Preeclampsia has become the most common glomerular-based kidney disease affecting up to 8% of normal pregnancies.^1–3 Thus, a worsening condition of preeclampsia will be related to an increasing risk of renal disease, particularly acute kidney injury (AKI).^1,2 Acute kidney injury has become the common renal disease complication due to severe preeclampsia with the incidence up to 5%.⁴ This complication is mainly caused by thrombotic microangiopathy involving renal arteries, which can be observed with an increasing urine D-dimer level. This study aims to determine the urine D-dimer level in severe preeclampsia-complicated AKI. Materials and methods: A cross-sectional study was conducted in Obstetric Emergency Unit and Obstetric Ward Unit, Cipto Mangunkusumo General Hospital, from January to April, 2013. Subjects were divided into two groups: severe preeclampsia-complicated AKI and normotensive pregnancy. The main outcome of this study was that urine D-dimer level was based on the cutoff point from receiver operating characteristic (ROC). The secondary outcomes were its sensitivity and specificity. Statistical analysis was performed using Mann–Whitney and Spearman correlation tests. Data were analyzed using SPSS 20.0. Results: There were 65 subjects collected during the study and divided into two groups: 35 patients with severe preeclampsia-complicated AKI and 30 patients with normotensive pregnancy. There was a significant increase in the urine D-dimer level in patients with severe preeclampsia-complicated AKI compared with patients with normotensive pregnancy (2503 ng/mL vs 236.2 ng/mL; p = 0.001). Based on the ROC, the cutoff point for the urine D-dimer level was >818 ng/dL with area under the ROC curve was 0.819 (81.9%), sensitivity 80%, and specificity 73%. Conclusion: The urine D-dimer level significantly increased in severe preeclampsia-complicated AKI with a cutoff point of >818 ng/dL, sensitivity 80%, and specificity 73%.