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Polycystic kidney disease

Reviewed June 2006

What is polycystic kidney disease?

Polycystic kidney disease is a disorder that affects the kidneys and other organs. Clusters of fluid-filled sacs, called cysts, develop in the kidneys and interfere with their ability to filter waste products from the blood. The growth of cysts causes the kidneys to become enlarged and can lead to kidney failure. Cysts may also develop in other organs, particularly the liver.

Frequent complications of polycystic kidney disease include dangerously high blood pressure (hypertension), pain in the back or sides, blood in the urine (hematuria), recurrent urinary tract infections, kidney stones, and heart valve abnormalities. Additionally, people with polycystic kidney disease have an increased risk of an abnormal bulging (an aneurysm) in a large blood vessel called the aorta or in blood vessels at the base of the brain. Aneurysms can be life-threatening if they tear or rupture.

The two major forms of polycystic kidney disease are distinguished by the usual age of onset and their pattern of inheritance. The autosomal dominant form (sometimes called ADPKD) has signs and symptoms that typically begin in adulthood, although cysts in the kidney are often present from childhood. Autosomal dominant polycystic kidney disease can be further divided into type 1 and type 2, depending on which gene is mutated. The autosomal recessive form of polycystic kidney disease (sometimes called ARPKD) is much rarer and is often lethal early in life. The signs and symptoms of this condition are usually apparent at birth or in early infancy.

How common is polycystic kidney disease?

Polycystic kidney disease is one of the most common disorders caused by mutations in a single gene. It affects about 500,000 people in the United States. The autosomal dominant form of the disease is much more common than the autosomal recessive form. Autosomal dominant polycystic kidney disease affects 1 in 500-1,000 people, while the autosomal recessive type occurs in an estimated 1 in 20,000-40,000 people.

What genes are related to polycystic kidney disease?

Mutations in the PKD1, PKD2, and PKHD1 genes cause polycystic kidney disease.

Mutations in either the PKD1 or PKD2 gene can cause autosomal dominant polycystic kidney disease. These genes provide instructions for making proteins whose functions are not fully understood. Researchers believe that they are involved in transmitting chemical signals from outside the cell to the cell's nucleus. The two proteins work together to promote normal kidney development, organization, and function. Mutations in the PKD1 or PKD2 gene lead to the formation of thousands of cysts, which disrupt the normal functions of the kidneys and other organs. People with mutations in the PKD2 gene, particularly women, typically have a less severe form of the disease than people with PKD1 mutations. The signs and symptoms, including a decline in kidney function, tend to appear later in adulthood in people with a PKD2 mutation.

Mutations in the PKHD1 gene cause autosomal recessive polycystic kidney disease. This gene provides instructions for making a protein whose exact function is unknown; however, the protein likely transmits chemical signals from outside the cell to the cell nucleus. Researchers have not determined how mutations in the PKHD1 gene lead to the formation of numerous cysts characteristic of polycystic kidney disease.

Although polycystic kidney disease is usually a genetic disorder, a small percentage of cases are not caused by gene mutations. These nonhereditary cases are called acquired polycystic kidney disease. This form of the disorder occurs most often in people who have been treated for several years with hemodialysis (a procedure that filters the blood in people with kidney failure).

How do people inherit polycystic kidney disease?

Most cases of polycystic kidney disease have an autosomal dominant pattern of inheritance. People with this condition are born with one mutated copy of the PKD1 or PKD2 gene in each cell. In about 90 percent of these cases, an affected person inherits the mutation from one affected parent. The other 10 percent of cases result from new mutations in one of the genes and occur in people with no history of the disorder in their family.

Although one altered copy of a gene in each cell is sufficient to cause the disorder, an additional mutation in the second copy of the PKD1 or PKD2 gene may make cysts grow faster and increase the severity of the disease. The rate at which cysts enlarge and cause a loss of kidney function varies widely, and may be influenced by mutations in other, as yet unidentified, genes.

Polycystic kidney disease also can be inherited in an autosomal recessive pattern. People with this form of the condition have two altered copies of the PKHD1 gene in each cell. The parents of a child with an autosomal recessive disorder are not affected but are carriers of one copy of the altered gene.

Where can I find information about treatment for polycystic kidney disease?

You may find information on treatment or management of polycystic kidney disease or some of its symptoms in the links below, particularly the links for Gene Reviews, MedlinePlus Encyclopedia, Educational resources, and Patient support.

Where can I find additional information about polycystic kidney disease?

You may find the following resources about polycystic kidney disease helpful. These materials are written for the general public.

  • MedlinePlus - Health information
    • Encyclopedia: Polycystic kidney disease (http://www.nlm.nih.gov/medlineplus/ency/article/000502.htm)
    • Health Topic: Kidney Diseases (http://www.nlm.nih.gov/medlineplus/kidneydiseases.html)
  • Genetic and Rare Diseases Information Center - Information about genetic conditions and rare diseases (http://rarediseases.info.nih.gov/GARD/Disease.aspx?PageID=4&DiseaseID=10413)
  • Additional NIH Resources - National Institutes of Health
    • National Center for Biotechnology Information: Genes and Disease (http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=gnd.section.109)
    • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (http://kidney.niddk.nih.gov/kudiseases/pubs/polycystic/index.htm)
  • Educational resources - Information pages
    • Children's Hospital Boston (http://www.childrenshospital.org/az/Site1464/mainpageS1464P0.html)
    • Merck Manual of Medical Information, Second Home Edition (http://www.merck.com/mmhe/sec11/ch146/ch146k.html)
    • New York Online Access to Health (http://www.noah-health.org/en/kidver/kidney/specific/cysts.html)
    • Orphanet: Polycystic kidney disease, dominant type (http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=EN&Expert=730)
    • Orphanet: Polycystic kidney disease, recessive type (http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=EN&Expert=731)
  • Patient support - For patients and families
    • American Association of Kidney Patients (http://www.aakp.org/)
    • Genetic Alliance (http://www.geneticalliance.org/ws_display.asp?filter=infosearch_results&info_keyword=Autosomal+Recessive+Polycystic+Kidney+Disease&expand=Treatment)
    • Kidney and Urology Foundation of America (http://www.kidneyurology.org/)
    • Kidney Research UK (http://kidneyresearchuk.org/)
    • National Kidney Foundation (http://www.kidney.org/atoz/atozItem.cfm?id=102)
    • National Organization for Rare Disorders (http://www.rarediseases.org/search/rdbdetail_abstract.html?disname=Polycystic+Kidney+Diseases)
    • PKD Foundation (http://www.pkdcure.org/)
    • Resource list from the University of Kansas Medical Center (http://www.kumc.edu/gec/support/polycyst.html)

You may also be interested in these resources, which are designed for healthcare professionals and researchers.

  • Gene Reviews - Clinical summary
    • Gene Review: Polycystic Kidney Disease, Autosomal Dominant (http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=pkd-ad)
    • Gene Review: Polycystic Kidney Disease, Autosomal Recessive (http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=pkd-ar)
  • Gene Tests - DNA tests ordered by healthcare professionals
    • Gene Tests: Polycystic Kidney Disease, Autosomal Recessive (http://www.genetests.org/query?testid=2771)
    • Gene Tests: Polycystic Kidney Disease 1, Autosomal Dominant (http://www.genetests.org/query?testid=78527)
    • Gene Tests: Polycystic Kidney Disease 2, Autosomal Dominant (http://www.genetests.org/query?testid=78530)
  • Genetic Tools - Teaching cases (http://www.genetests.org/servlet/access?fcn=y&filename=/tools/cases/renal-33/)
  • ClinicalTrials.gov - Linking patients to medical research (http://clinicaltrials.gov/search/condition=%22polycystic+kidney+disease%22)
  • PubMed - Recent literature (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=PubMed&term=((Polycystic+Kidney+Diseases[MAJR])+OR+(Polycystic+Kidney,+Autosomal+Dominant[MAJR])+OR+(Polycystic+Kidney,+Autosomal+Recessive[MAJR]))+AND+(polycystic+kidney+disease[TI])+AND+review[pt]+AND+english[la]+AND+human[mh]&orig_db=PubMed&filters=ON&pmfilter_EDatLimit=1440+Days)
  • Online Books - Medical and science texts
    Scriver's Online Metabolic and Molecular Bases of Inherited Disease (OMMBID): Autosomal Dominant Polycystic Kidney Disease (http://books.mcgraw-hill.com/getommbid.php?isbn=0071459960&template=ommbid&c=215)
  • OMIM - Genetic disorder catalog
    • OMIM topic: Polycystic kidney disease (autosomal recessive) (http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=263200)
    • OMIM topic: Polycystic kidneys (autosomal dominant) (http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=173900)

What other names do people use for polycystic kidney disease?

  • PKD
  • Polycystic renal disease

See How are genetic conditions and genes named? (http://ghr.nlm.nih.gov/handbook/mutationsanddisorders/naming) in the Handbook.

What if I still have specific questions about polycystic kidney disease?

  • See How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.
  • Ask the Genetic and Rare Diseases Information Center (http://rarediseases.info.nih.gov/GARD/).
  • Submit your question to Ask the Geneticist (http://www.askthegen.org/).

What glossary definitions help with understanding polycystic kidney disease?

aneurysm ; aorta ; autosomal ; autosomal dominant ; autosomal recessive ; carrier ; cell ; cell nucleus ; complication ; cysts ; end-stage renal disease ; gene ; heart valve ; hematuria ; hemodialysis ; hypertension ; infection ; inheritance ; kidney ; kidney stones ; mutation ; new mutation ; nucleus ; pattern of inheritance ; polycystic kidney ; protein ; recessive ; renal ; renal disease ; rupture ; sign ; stage ; stone ; symptom

You may find definitions for these and many other terms in the Genetics Home Reference Glossary (http://ghr.nlm.nih.gov/glossary).

References
  • Adeva M, El-Youssef M, Rossetti S, Kamath PS, Kubly V, Consugar MB, Milliner DM, King BF, Torres VE, Harris PC. Clinical and molecular characterization defines a broadened spectrum of autosomal recessive polycystic kidney disease (ARPKD). Medicine (Baltimore). 2006 Jan;85(1):1-21. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=Abstract&list_uids=16523049)
  • Boucher C, Sandford R. Autosomal dominant polycystic kidney disease (ADPKD, MIM 173900, PKD1 and PKD2 genes, protein products known as polycystin-1 and polycystin-2). Eur J Hum Genet. 2004 May;12(5):347-54. Review. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=Abstract&list_uids=14872199)
  • Gene Review: Polycystic Kidney Disease, Autosomal Dominant (http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=pkd-ad)
  • Gene Review: Polycystic Kidney Disease, Autosomal Recessive (http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=pkd-ar)
  • Hateboer N, v Dijk MA, Bogdanova N, Coto E, Saggar-Malik AK, San Millan JL, Torra R, Breuning M, Ravine D. Comparison of phenotypes of polycystic kidney disease types 1 and 2. European PKD1-PKD2 Study Group. Lancet. 1999 Jan 9;353(9147):103-7. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=Abstract&list_uids=10023895)
  • Horie S. ADPKD: molecular characterization and quest for treatment. Clin Exp Nephrol. 2005 Dec;9(4):282-91. Review. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=Abstract&list_uids=16362154)
  • Igarashi P, Somlo S. Genetics and pathogenesis of polycystic kidney disease. J Am Soc Nephrol. 2002 Sep;13(9):2384-98. Review. No abstract available. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=Abstract&list_uids=12191984)
  • Lina F, Satlinb LM. Polycystic kidney disease: the cilium as a common pathway in cystogenesis. Curr Opin Pediatr. 2004 Apr;16(2):171-6. Review. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=Abstract&list_uids=15021197)
  • Scriver, Charles R; The metabolic & molecular bases of inherited disease; 8th ed.; New York : McGraw-Hill, c2001. p5467-5489.
  • Tahvanainen E, Tahvanainen P, Kaariainen H, Hockerstedt K. Polycystic liver and kidney diseases. Ann Med. 2005;37(8):546-55. Review. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=Abstract&list_uids=16338757)
  • Wilson PD. Polycystic kidney disease. N Engl J Med. 2004 Jan 8;350(2):151-64. Review. No abstract available. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=Abstract&list_uids=14711914)

 

The resources on this site should not be used as a substitute for professional medical care or advice. Users seeking information about a personal genetic disease, syndrome, or condition should consult with a qualified healthcare professional. See How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.

 
Reviewed: June 2006
Published: May 11, 2009