Objective To investigate the value of serum interleukin-18 (IL-18), cystatin C (CysC), urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) in predicting the risk of renal injury in hypertensive patients during pregnancy. Methods Clinical data of 96 patients with pregnancy-induced hypertension admitted to our hospital from February 2022 to February 2023 were retrospectively analyzed, and the patients were divided into two groups according to whether they had kidney injury (n=40) and non-kidney injury (n=56). The clinical data of the two groups were compared, and the levels of serum IL-18, CysC and urine NGAL and KIM-1 were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of kidney injury in hypertensive patients during pregnancy. The value of kidney injury risk prediction model in hypertensive patients during pregnancy was analyzed by receiver operating characteristic curve (ROC). Results The proportion of patients with severe postpartum hemorrhage and pulmonary hypertension in kidney injury group was higher than that in non-kidney injury group, and the levels of serum IL-18, CysC, urine NGAL and KIM-1 were higher than those in non-kidney injury group (P < 0.05). After ROC analysis, the areas under the curve of serum IL-18, CysC and urine NGAL and KIM-1 to predict the risk of renal injury in hypertensive patients during pregnancy were 0.788 (95%CI: 0.695 ~ 0.881), 0.733 (95%CI: 0.627 ~ 0.839), 0.709 (95%CI: 0.603 ~ 0.816), 0.815 (95%CI: 0.724 ~ 0.905), the critical values were 53.270 ng/L, 1.370 mg/L, 37.610 g/L, 5.110 ng/mL, and the sensitivity were 0.800 (95%CI: 0.712 ~ 0.886), 0.600 (95%CI: 0.521 ~ 0.743), 0.600 (95%CI: 0.517 ~ 0.704), 0.825 (95%CI: 0.733 ~ 0.916), the specificity were 0.714 (95%CI: 0.622 ~ 0.837), 0.821 (95%CI: 0.711 ~ 0.909), 0.732 (95%CI: 0.656 ~ 0.841), 0.732 (95%CI: 0.632 ~ 0.825). Multivariate Logistic regression analysis showed that severe postpartum hemorrhage (OR=1.859, 95%CI: 1.181-2.926), pulmonary hypertension (OR=1.934, 95%CI: 1.205 ~ 3.104), IL-18≥53.270 ng/L (OR=2.947, 95%CI: 1.422 ~ 6.107), CysC≥1.370 mg/L (OR=3.125, 95%CI: 1.508 ~ 6.476), NGAL≥37.610 g/L (OR=2.688, 95%CI: 1.451 ~ 4.980) and KIM-1≥5.110 ng/mL (OR=2.727, 95%CI: 1.367 ~ 5.440) were risk factors for renal injury in hypertensive patients during pregnancy (P < 0.05). The risk prediction model of kidney injury in hypertensive patients during pregnancy was established based on multivariate Logistic regression analysis. Logit (P) =-34.437+0.620× severe postpartum hemorrhage +0.660× pulmonary hypertension +1.081×IL-18+1.139×CysC+0.989×NGAL+1.003×KIM-1, by ROC analysis, the area under the curve for predicting the risk of renal injury in hypertensive patients during pregnancy was 0.972 (95%CI: 0.944 ~ 1.000), standard error: 0.015, P value: 0.000, sensitivity: 0.950 (95%CI: 0.841 ~ 0.993), specificity: 0.929 (95%CI: 0.839 ~ 0.997). Conclusion Serum IL-18, CysC and urine NGAL and KIM-1 levels can reflect the risk of kidney injury in hypertensive patients during pregnancy to a certain extent. The establishment of a prediction model can greatly improve the sensitivity and specificity of the above indexes in predicting kidney injury, with higher prediction value.