Autosomal Dominant Polycystic Kidney Disease
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder. Fluid-filled cysts grow within the kidneys over decades, enlarging the organs and gradually crowding out healthy tissue. Most people inherit a mutation in the PKD1 or PKD2 gene from one parent; roughly half of their children will carry it too.
Key points
- The disease is caused by an inherited mutation in one of two genes, PKD1 or PKD2, letting fluid-filled cysts slowly enlarge the kidneys.
- Many stay free of symptoms into their thirties or forties, when blood in the urine, flank pain or repeated kidney infections can start to appear.
- Tolvaptan, a vasopressin-blocking medicine, can slow the growth in total kidney volume for adults at risk of rapid progression, alongside staying well hydrated.
How the condition progresses
Cysts are usually silent in childhood and early adulthood. By the third or fourth decade, many people notice flank pain, blood in the urine, or frequent kidney infections. High blood pressure appears early and is one of the main drivers of long-term damage. In a proportion of patients the kidneys eventually lose enough function to require dialysis or transplant, though the timeline varies widely, PKD2 mutations tend to progress more slowly than PKD1.
Slowing cyst growth
Keeping blood pressure tightly controlled is central to management. Beyond that, a vasopressin receptor antagonist called tolvaptan has been shown to slow the rate of total kidney volume increase in adults at risk of rapid progression. Staying well hydrated, aiming for pale urine throughout the day, reduces vasopressin release and complements this approach. Salt restriction, a healthy weight, and avoiding nephrotoxic substances (including high-dose NSAIDs) are widely recommended.
Persistent or severe symptoms, worsening flank pain, a sudden drop in urine output, or repeated infections, warrant prompt medical assessment.