Autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of chronic kidney disease, resulting in substantial morbidity and mortality globally. Advances in molecular genetics and deep-phenotype imaging techniques have refined existing diagnostic and prognostic tools. The strong evidence-base for tolvaptan as a disease-modifying treatment supports its early use in groups at high risk of kidney failure. Screening and management of potentially serious complications including cyst infection, intracranial aneurysms, and polycystic liver disease are important components of a comprehensive care plan. This Review focuses on current approaches to diagnosis, risk assessment, treatment, and specific aspects of clinical management in ADPKD. An updated understanding of the genetic basis of disease, pathobiology with respect to potential therapeutic targets, and promising therapies now in clinical trials are summarised. We propose a holistic patient-centred care pathway that emphasises shared decision-making with a multidisciplinary clinical team to address the individual needs of patients throughout their lifelong journey.