A 32 year old man presented with painless hematuria. He is hypertensive but the rest of the exam is unremarkable. What is the most likely diagnosis?

The key is A. Polycystic kidneys. [Autosomal dominant polycystic kidney disease (ADPKD) is a multisystemic and progressive disorder characterized by cyst formation and enlargement in the kidney and other organs (eg, liver, pancreas, spleen). Up to 50% of patients with ADPKD require renal replacement therapy by 60 years of age. In younger cysts may be smaller to palpate. Renal ultrasound is used to diagnose the condition]