The variation in disease severity among family members, particularly the more rapid progression in our patient compared to his father with ADPKD alone, suggests that NF1 may have influenced cystic disease progression. Given that NF1 mutations are known to affect intracellular signaling pathways, including the mTOR pathway, their potential role in modulating ADPKD severity warrants further consideration. This evidence concerns the gene MTOR and autosomal dominant polycystic kidney disease.