Young asymptomatic adult with a family history of autosomal dominant polycystic kidney disease Multiple, bilateral kidney cysts on ultrasound – meeting the Pei–Ravine unified ultrasound criteria2 Progressive symptomatic complications in approximately 60% with ageing (kidney pain, chronic kidney disease, hypertension or kidney failure) Variable extrarenal complications: aneurysms (intracranial 6–20%; aortic 5%), extrarenal cysts (hepatic >90%, 5% symptomatic), diverticular disease (40%), abdominal hernias (inguinal, incisional or para-umbilical 45%) and depression (up to 60%) Elevated risk of premature cardiovascular disease (50%) due to hypertension, chronic kidney disease or cardiac valvular abnormalities