A Review of the Management of Nephrolithiasis in Autosomal Dominant Polycystic Kidney Disease.

Autosomal dominant polycystic kidney disease (ADPKD) is a chronic hereditary disorder and a major cause of end-stage renal disease (ESRD). Urolithiasis is a frequent complication in ADPKD and may contribute to the accelerated decline in renal function. The presence of complex calyceal anatomy, impaired renal function, and associated comorbidities makes stone management particularly challenging in this population. We conducted a narrative review of the literature to explore the underlying reasons for the high incidence of nephrolithiasis in ADPKD, as well as current approaches to management. A targeted literature search was performed in MEDLINE, EMBASE, Google Scholar, and Web of Science for articles published up to February 2025 using the keywords "ADPKD", "nephrolithiasis", "kidney stones," "urolithiasis," "management", and "treatment". Only English-language articles involving human subjects were considered. Original studies, meta-analyses, narrative, and systematic reviews relevant to nephrolithiasis in ADPKD were included. Conference abstracts, editorials, and non-peer-reviewed sources were excluded. Both medical and surgical treatment modalities were evaluated, with attention to reported success rates and complication profiles. Although this is a narrative review and no formal risk of bias assessment was performed, emphasis was placed on including high-quality studies and widely cited literature. Key findings were synthesized thematically to provide an overview of current understanding and management of nephrolithiasis in ADPKD. Small sample sizes and significant heterogeneity in study design, patient selection, and treatment protocols limit available evidence. While the general principles of stone management are similar to those in non-ADPKD patients, therapeutic decisions must be tailored to stone size, location, composition, renal function, and anatomical considerations. Based on the literature, we propose a treatment algorithm to support clinical decision-making. Standardization of management strategies in ADPKD remains an unmet need. Larger, well-designed studies are required to establish evidence-based guidelines for optimal care.