This is compatible with the finding that adults with ADPKD also suffer considerable cardiovascular damage prior to decline of kidney function which probably relates to activation of the renin-angiotensin system by ischemic cyst compression and loss of PKD1/2-dependent production of nitric oxide by vascular smooth muscle cells [13, 20, 21]. The gene discussed is REN; the disease is autosomal dominant polycystic kidney disease.