Symptoms

The symptoms of autosomal dominant polycystic kidney disease (ADPKD) are caused by the growth of fluid-filled sacs (cysts)in the kidneys.

AlthoughADPKD is present from birth, it may not cause any obvious problems until the cysts have reached a size where they significantly affect how well your kidneys work. In most cases, this doesn't happen until 30 to 60 years of age.

The growth of the cysts can eventually cause your kidneys to increase in size. In some cases, the kidneys of older adults with ADPKD can be three or fourtimes larger than those of adults who don't have the condition.

Problems caused by ADPKD

The growth ofcysts in your kidneys can cause a wide range of problems, including:

• painin your abdomen (tummy), side or lower back
• blood in your urine (haematuria)
• high blood pressure (hypertension)
• kidney stones
• recurrenturinary tract infections (UTIs)
• eventually, loss of kidney function known aschronic kidney disease (CKD)

These problems are described in more detail below.

Pain

Pain in the abdomen, side or lower back is often the first noticeable symptom of ADPKD.This can be severe, but is usually short-lived lasting from a few minutes to several days.

Common causes of pain associated with ADPKD include:

• a cyst becoming larger
• bleeding into one or more cysts
• a kidney stone
• a kidney or other part of your urinary system, such as your bladder, becoming infected (a UTI)

Blood in your urine

Blood in your urine (haematuria) is another common initial symptom of ADPKD. Although it can often be a frightening symptom, it isn't usually a cause for concern and most cases will resolve within a week without the need for treatment.

However, you should go to see your GP if you notice blood in your urine so that other possible causes, such as a growth in your bladder, can be investigated and excluded.

High blood pressure

Many experts consider high blood pressure to be the first effect of ADPKD butasit often doesn't cause any obvious symptoms, it's only usually detected during routine testing.

Symptoms only occur when blood pressure reaches a very high level, which is rare.In such circumstances, symptoms can include:

• a persistent headache
• blurred or double vision
• nosebleeds
• shortness of breath

See your GP immediately if you experience these symptoms so that the cause can be investigated. Untreated or poorly controlled high blood pressure is a major risk factor for a number of serious health conditions including heart attack , stroke , and kidney failure.

Kidney stones

HavingADPKD puts you at increased risk of developing kidney stones .

Smaller kidney stonesmay pass out of your kidneys without causing any symptoms, but larger stones can get blocked in your kidney or ureter (the tube that connects your kidney to your bladder), causing problems such as:

• intense pain in the back or side of your abdomen, or occasionally in your groin the pain may last for minutes or hours, with pain-free intervals in between
• feeling restless and unable to lie still
• feeling sick
• needing to urinate more often than normal
• blood in your urine

Contact your GP if you think you may have a kidney stone so they can try to find out what's causing your symptoms.

Urinary tract infections (UTIs)

Urinary tract infections (UTIs) are broadly classified into one of two groups lower UTIs and upper UTIs.

A lower UTI is an infection that develops in your bladder or urethra (the tube that carries urine out of the body). An upper UTI is an infection that develops in your kidneys or ureters (the tubes that link your kidneys to your bladder).

ADPKD doesn't increase your risk of developing lower UTIs such as bladder infections ( cystitis ), but it can mean that any lower UTIs you do develop could spread to your kidneys and become potentially serious upper UTIs.

Symptoms of a lower UTI caninclude:

• cloudy urine
• a need to urinate more frequently, either during the day or night, or both
• pain or discomfort when passing urine
• an urgent need to urinate (holding urine in becomes more difficult)
• unpleasant smelling urine

Symptoms of an upper UTI can include:

• a high temperature (fever) of 38C (100.4F) or above
• uncontrollable shivering
• feeling sick
• vomiting
• diarrhoea

Visit your GP if you have ADPKD and you think you may have a UTI. Youmay need treatment to stop the infection spreading into the cysts in your kidneys.

Chronic kidney disease (CKD)

Most people with ADPKDwill eventually lose a significant amount of kidney function. Loss of kidney function caused by kidney damage is known as chronic kidney disease (CKD) .

CKD doesn't usually cause symptoms until it's reached an advanced stage, known as CKD stage 4 (when 75% of kidney function has been lost).

The most advanced stage of CKD (stage 5) is called kidney failure or end-stage renal disease. This is when dialysis (removal ofwaste products and excess fluid from the blood) is essential to keep the person alive.

Symptoms of kidney failure include:

• poor appetite and weight loss
• swollen ankles, feet or hands ( oedema )
• shortness of breath
• an increased need to urinate, particularly at night
• itchy skin
• feeling sick
• in men, erectile dysfunction
• in women, absent periods (amenorrhoea)
• difficulty concentrating

Kidney failure rarely happens suddenly, and treatment options should have been discussed and a treatment plan chosen before this stage is reached.