Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common causes of chronic renal failure. Currently, there are no established specific treatments to prevent or slow down the progression of the disease. The last decade, however, has witnessed a significant effort to improve the prognosis of patients with ADPKD. Patients with chronic renal failure are now offered different therapies such as a low-protein diet, angiotensin II converting enzyme inhibitors or receptor blockers, and statins. In addition, a number of important breakthroughs have greatly advanced our understanding of the pathogenesis of ADPKD. These have led to several novel therapeutic approaches directed either at inhibiting the proliferation of cyst epithelium (antisense C-myc oligonucleotides, EGFR tyrosine kinase inhibitors, caspase inhibitors, paclitaxel, rapamycin, CDK inhibitors) or at decreasing cyst fluid secretion (Na transport inhibition, vasopressin V2 receptor antagonists, somatostatin). Some of these novel approaches have not yet been tested in the clinical setting, others are the object of ongoing studies. It seems likely that in the next few years treatment of patients with ADPKD will radically change from one of passive follow-up to one of active treatment, probably with protocols combining different drugs targeting the different pathogenetic mechanisms of the disease.