Autosomal Dominant Polycystic Kidney Disease (ADPKD), an inherited progressive kidney disease, is the fourth leading cause of kidney failure in the US. ADPKD has a spectrum of clinical and imaging features that have direct prognostic implications1. Total kidney volume (TKV), adjusted for height and age, has been shown to be the best predictor of kidney function decline; this forms the basis for the Mayo Clinic Imaging Classification (MCIC) of the severity grade of ADPKD1. Radiology’s central role in ADPKD is to aid in the imaging-based diagnosis, prognostication, and monitoring for disease progression.