In autosomal dominant polycystic kidney disease (ADPKD), what does imaging typically show early in the disease?

• A. Imaging shows multiple bilateral renal cysts with preserved kidney function early.
• B. Imaging shows liver cysts only.
• C. Imaging shows solitary renal mass.
• D. Imaging shows calyceal dilation without cysts.

Answer: (A)

In autosomal dominant polycystic kidney disease, the imaging hallmark early on is multiple cysts in both kidneys while kidney function remains preserved. This bilateral renal cyst burden reflects the disease’s cyst-forming process in the kidneys before significant loss of filtration occurs, so patients can have normal or near-normal kidney function despite clear cystic changes on imaging. Liver cysts can appear as an extrarenal feature later, but they’re not the primary early renal finding. A solitary renal mass would raise concern for a tumor, and calyceal dilation without cysts suggests obstruction or another non-cystic process, not the typical early picture of ADPKD.