Since it is one of the commonest hereditary diseases, causing serious illness in adulthood, autosomal dominant polycystic kidney disease (ADPKD) is a problem for both the affected families and for the health economy of the society. The current management of ADPKD is reviewed with emphasis on the development of predictive DNA analyses, the recently discovered genetic heterogeneity, and ethical perspectives. Insurance aspects are discussed, and the need for access to selective reproductive prevention as well as for improvement of conventional therapeutic measures is stressed.