For many years, those who studied renal disease recognized a strong correlation between diet and disease progression. Diet therapy, now referred to as medical nutrition therapy, has long been investigated in the treatment of kidney insufficiency and kidney failure. Given that the kidneys have numerous vital functions, including a primary role in the excretion of waste products and urine, the diminishing effects of aging and disease on the kidney require adaptation of the nutrition consumed. Over the years, numerous theories have evolved as treatment modalities. This article explores the history of dietary management of kidney disease going back to leading researchers including Borst, Giovannetti, and Kopple, along with others. Clinicians have witnessed the historic development of national guidelines and protocols for nutrition treatment of chronic kidney disease and acute kidney injury, leading to improved uniformity among practitioners. Some of the changes in medical nutrition therapy and specialized nutrition support are addressed.