<p>A hereditary disorder called autosomal dominant polycystic kidney disease (ADPKD) results from changes in the PKD1 and PKD2 genes. The most typical indication of ADPKD is the progressive growth of many kidney cysts, which ultimately results in end-stage kidney disease (ESKD) and necessitates renal replacement treatment. Numerous therapies have been developed to treat ADPKD. Not all these treatments, meanwhile, have been successful in stopping the disease's progression. Before beginning a specific therapy to regulate ADPKD, it is imperative to have a comprehensive understanding of the mechanisms causing cyst formation and expansion. Over the past 20&#xa0;years, intense research efforts have led to many clinical trials aimed at treating ADPKD. Even though Tolvaptan has several unfavourable side effects, such as liver damage, thirst, and polyuria when taken for an extended period of time, it is the only medication that has been identified as effective in postponing the decrease in kidney function in ADPKD. In this review, we have discussed the molecular mechanisms and comprehensive pathophysiology of PKD, as well as the potential for new treatments to advance the disease's clinical development.</p> Graphical abstract <p>Overview of cellular, molecular, and epigenetic mechanisms involved in cyst formation in advancing autosomal dominant polycystic kidney disease</p> <p></p>