The publication claims that the 20-year stagnation of the clinical settings of the concepts of Kidney Disease Improving Global Outcomes (KDIGO) and Chronic Kidney Disease (CKD), their operation with distorted beliefs about renal processes and functions stems from the conceptual essence of KDIGO and CKD as a condition with significant loss of renal tissue mass corresponding to the syndrome, unable to approach the functional diagnosis of initial stages of chronic nephropathies. The article develops I. Davydovsky's idea of pragmatism as a purely medical understanding of a biological phenomenon, which is a pathological process, without comprehension its historical content, the fruitfulness of which (comprehension) for the clinic at the time of the formation of the concepts of KDIGO and CKD was proved by evolutionary physiology, which has thoroughly studied the comparative morphology and physiology of vertebrates patterns of evolutionary development of excretory organs. Examples of underlying clinical equivalents to the manifestations of functional stages of the historical development of the kidneys, ignored by concepts due to the utilitarian pragmatism of clinical thinking, are given. The validity of the practical use of the provisions of evolutionary physiology is proved by their fundamental role in the development of space biology and medicine, which far outstripped the emergence of the concepts of KDIGO and CKD. The focus of modern research on the epidemiology of CKD, which is not related to the concepts under consideration, turns out to be the molecular mechanisms of both embryogenesis and nephrosclerosis, the interpretation of which in terms of evolutionary biology has shaped evolutionary nephrology. The facts of expression of the same genes revealed by her, as in normal nephrogenesis, as in nephrosclerosis, determine the vector of searches for antifibrogenic interventions and confirm the applicability to the phenomena of pathology of the statement of one of the founders of the synthetic theory of evolution Th. Dobzhansky that « ...nothing in biology makes sense except in the light of evolution… »