Abstract Background and Aims Prediction of pre-eclampsia early in pregnancy can reduce its incidence and subsequent maternal and fetal morbidity and mortality. The sensitivity of current biomarkers is fair despite being used in clinical settings. Podocyturia was found to be a useful biomarker of preeclampsia with high sensitivity and specificity. UTF21 is highly expressed on podocytes. We investigated the relationship between urine transcription factor 21 as a new biomarker and preeclampsia. Method 160 pregnant women with pre-eclampsia and age and gestational age matched 64 pregnant women with normal pregnancy were recruited. Pre-eclamptic patients were subdivided into mild (92 pregnant patients) and severe (68 pregnant patients). Each group is subdivided into early-onset and late-onset preeclampsia. Urine transcription factor 21 and compared with serum PlGF and sFlts were measured. The sFlt/PlGF ratio was calculated. Results The mean Urine transcription factor 21 was significantly higher in pregnant patients with preeclampsia than in healthy pregnant controls (512.3 ± 281.4 vs. 300 ± 66.8; p<0.001). Urine TCF21 could not differentiate between early- and late-onset preeclampsia with the mean urine TCF21 was higher in early-onset preeclampsia than late-onset preeclampsia (532.63 ± 312.33 vs. 491.41 ± 248.1, p=0.519). Urine TCF21 was statistically significantly higher in mild preeclampsia than severe preeclampsia (572.3 ± 300.9 vs. 361.9 ± 155.8, p<0.001). The sensitivity and specificity of urine TCF21 was 60.62% and 90.62% when using 370 pg/mL as cutoff in the prediction of preeclampsia development. Conclusion Urine transcription factor 21 can be used as a possible and easy diagnostic marker for preeclampsia. It can differentiate between mild and severe preeclampsia but cannot be used to differentiate between early- and late-preeclampsia.