An emergency related to managing freshwater streams is affecting urban and periurban areas in many countries worldwide. This has been brought about by climate change and particularly aggressive anthropogenic actions, which have proven over time to be counterproductive and detrimental to their respective territories and also to the balance of the broader environmental ecosystem. Extreme droughts and the risk of flooding are two opposing, increasingly frequent phenomena related to the alteration of the natural course of rivers, compromising access to water resources, biodiversity, and food and energy production. Faced with such pressing issues, this journal issue is intended as an opportunity to update and discuss on the need to put water resources at the center of urban redevelopment projects. Better management of rivers and wetlands must start with respecting natural rhythms to integrate them with the more complex dynamics of development and management of urbanized areas. This requires awareness that, in addition to safeguarding our freshwater resources, such actions can also lead to ensuring greater adaptation of urban systems to the effects of climate. In this regard, a lesson comes from history, from past eras in which the modification of the environment to make it habitable by humans took place through adaptive modes. In those cases, spatial solutions were integrated with peculiar geographical features while respecting local natural resources and taking into account climatic conditions. These trends are inspired by an urban development model that is mindful of limited land resources such as water and soil, promoting urban regeneration interventions based on networks “of green and blue infrastructure used as an alternative to or in synergy with traditional gray infrastructure”. Recent years’ environmental, economic and social challenges demand attention, debate and concrete action on this paradigm shift.