as liver, pancreas, spleen, ovaries, and large bowel. Usually, these latter cysts do not impose a problem. Half of patients have no manifestation of symptoms, but symptoms may include: hematuria, back or abdominal pain, or the development of hypertension. The disease is usually manifested before age 30, and 45% develop kidney failure by age 60. Mutation in the HDK1 gene is currently thought to be responsible for autosomal recessive polycystic kidney disease (ARPKD), which can be diagnosed in the womb, shortly after birth, and usually before 15 years of age. Cause The site of preference for cyst development is the renal tubule. After growth of a few millimeters has occurred, the cysts detach from the parent tubule, this detachment induced by excessive proliferation of tubular epithelium or excessive fluid secretions. Diagnosis Diagnosis includes imaging with ultrasound, CT and/or MRI. The least expensive, non-invasive, and most reliable method is ultrasonography but smaller cysts may escape detection, while the resolution of CT and MRI will enable smaller cysts to be captured. However, the increased complexity and expense of CT and MRI is usually reserved for higher risk situations. MRI can be used to monitor the development of cysts and growth of kidneys.Genetic test can be applicable to those who have a family history of PKD but is expensive and fails to detect PKD in 15% of cases where it is present. Antenatal scans Many forms of cystic kidney disease can be detected in children prior to birth. Abnormalities, which only affect one kidney, are unlikely to cause a problem with the healthy arrival of a baby. Abnormalities which affect both kidneys can have an effect on the baby's amniotic fluid volume, which can in turn lead to problems with lung development. Some forms of obstruction can be very hard to differentiate from cystic renal disease on early scans. Treatment The goal of treatment is to manage the disease and its symptoms, and to avoid or delay complications. Options include pain medication (except ibuprofen and other ‘non-steroidal anti-inflammatory agents (NSAID’s)’ which may worsen kidney function), low protein and sodium diet, diuretics, antibiotics to treat urinary tract infection, or interventions to drain cysts. In advanced cystic kidney disease with renal failure, renal transplant or dialysis may ultimately be necessary. Prognosis By late 70s, 50-75% of patients with CKD require renal replacement therapy, either dialysis or kidney transplant. The number and size of cysts and