Evolutionary medicine, a new field that broadens study boundaries, has evolved in the last 20 years. Progressive kidney disease follows nephron loss, hyperfiltration, and inadequate healing, a process known as "maladaptive." Evolutionary adaptation, in contrast to physiological (homeostatic) adaptation, is the result of reproductive success, which represents natural selection. Environmental mismatch or evolutionary trade-offs can lead to evolutionary reasons for physiologically maladaptive responses. A fragile, energy-hungry renal tubule and a hypoxic, hyperosmolar microenvironment were produced as a result of evolutionary adaption to a terrestrial environment. Natural selection promotes a successful energy investment strategy: through the reproductive years, energy is committed to maintaining nephron integrity, but after age 40, this decreases due to senescence.
