In polycystic kidney disease, how does kidney enlargement affect function over time?

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Growth of cysts in polycystic kidney disease causes the kidneys to enlarge as cysts fill and expand. As these cysts grow, they replace normal kidney parenchyma and compress surrounding tissue, reducing functional nephron mass. The result is a gradual decline in filtration capacity over years, often with hypertension and an increased risk of infections and stones. Enlargement does not improve function, and kidney failure is not immediate; the loss of function progresses slowly as the disease advances.