Kidney insufficiency represents one of the most common and life-threatening disorders affecting companion animals, particularly dogs and cats. The present study aimed to evaluate the prevalence, the clinical manifestations, and therapeutic approaches associated with renal insufficiency in canine and feline patients. The research was conducted in a veterinary clinic from southern Romania, over a four-year period, and included a total of 30 patients diagnosed with chronic kidney disease (CKD), comprising 16 dogs and 14 cats. Diagnosis was established based on clinical examination and laboratory investigations, particularly serum creatinine and urea levels. The highest prevalence of CKD was observed in animals aged 11–20 years, confirming the strong correlation between age and renal pathology. Females were more frequently affected in both species, accounting for 75% of canine and 71% of feline cases. Most patients exhibited elevated biochemical parameters, with creatinine values exceeding 5 mg/dl predominantly in females, while nearly all animals presented urea levels above normal reference ranges. Statistical analysis of the collected data revealed no significant differences (p > 0.05) regarding the evaluated clinical manifestations (polydipsia, vomiting, diarrhea, constipation) or serum creatinine and urea values in relation to sex or age group. Anorexia showed borderline statistical significance (p = 0.045), suggesting its potential importance as an early clinical indicator. Diarrhea and constipation were also recorded but showed no statistically significant association with renal insufficiency (p > 0.05). Therapeutic management commonly included antibiotics, antiemetics, gastric protectants, analgesics, vitamin supplementation, fluid therapy, renal support products, and diuretics when necessary. Given the higher prevalence of chronic kidney disease observed in females, closer clinical monitoring and regular screening are recommended for this group. Early detection strategies should be encouraged, particularly in animals presenting anorexia, a clinical sign that showed borderline statistical significance and may serve as an important indicator in the early diagnosis of renal insufficiency.