Martin Barratt is a 40-year-old male with Autosomal Dominant Polycystic Kidney Disease (ADPKD). He was diagnosed at the age of 15 years when he was found to have bilateral cysts on renal MRI. The diagnosis was confirmed genetically (see attached result) and there is a strong family history of this condition. His mother is on dialysis and maternal grandfather had a kidney transplant and died from a ‘brain bleed’. Martin’s creatinine was elevated for a number of years and was measured at around 350 µmol/L (eGFR 18 ml/min/1.73m2) 3 years ago. Unfortunately, he was lost for nephrology follow up and was recently re-referred by his FD. He is seen by the nephrologist today and complains of fatigue and pruritus. Current medications include allopurinol 75 mg/daily. ROS was significant for erectile dysfunction and recent forearm fracture after a minor fall. He is also worried that his 15-year-old daughter could have the same condition and asks whether she needs to be tested. Physical examination shows a pale, malnourished male with BP of 169/92 mm Hg.