 Hello everybody, my name is Dr. Resham Khanna. Today I will be speaking about an interesting case a 50-year-old male patient presented with history of hematuria and pain and abdomen. Ultrasound examination revealed multiple large anechoic cysts with well-defined imperceptible walls showing posterior acoustic enhancement. Our diagnosis was adult polycystic kidney disease. There are two major types of adult polycystic kidney disease, autosomal dominant type and autosomal recessive type also called as the infantile polycystic kidney disease. Autosomal dominant polycystic kidney disease is a slowly progressive disease with nearly 100% penetrance. Its incidence is 1 in 1000 people. It is the third most prevalent cause of chronic renal failure. Mean age at diagnosis is 43 years. However, neonatal and infantile onset has also been reported. The incidence is equal in males and females. Oncet of cyst formation is most likely in the first decade. On ultrasound examination we see multiple cysts in cortical region, usually not seen prior to teens. Diffusely ecogenic when cysts are small in children, renal contour is poorly demarcated. Obstetric ultrasound shows large ecogenic kidneys similar to infantile polycystic kidney disease usually seen in third trimester, earlier seen at 14 weeks. It can be unilateral. Macroscopic cysts are rare. There is normal amount of amniotic fluid or oligohydramnios, renal function is not impaired. Complications include death from uremia, cerebral hemorrhage, secondary to hypertension or ruptured aneurysm, renal calculi, UTI, cyst rupture, hemorrhage and these patients are at an increased risk of renal cell carcinoma. Cysts may calcify in curvilinear rim, polycystic kidneys shrink after beginning of renal failure, after renal transplant or on chronic hemodialysis. Nuclear scan shows poor renal function on DTP-99M technician scan. They are associated with cysts in liver and pancreas, sacular berry aneurysms of cerebral arteries, mitral valve prolapse, hypertension, azotemia, hematuria, proteinuria, lumbar or abdominal pain. The kidneys appear large bilaterally with multifocal round lesions, unilateral enlargement may be the first manifestation of the disease. The differential diagnosis includes multiple simple cysts, these are less diffuse and show no family history, Vaughan-Hippel-Lindau disease acquired uremic cystic disease in which kidneys are small, there is no renal function and they are seen post transplant and infantile polycystic kidney disease that includes microscopic cysts. The take home message from this case is that we need to do routine screening ultrasound examination of children and siblings of persons having autosomal dominant polycystic kidney disease. This can help in early detection of disease and complications and can help make management relatively less challenging. Thank you very much.