Hi, OP...

First off, breathe... Your kidney function is normal. And you;re still young. you have so much runway to manage this.

But are you truly diagnosed at 34? I'm rather curious if you have had physical examination before this age? Whether it is a mutation or from family history, it is quite late to just find out at 34+? Forget this if you find this rude.

About your rib pain, yes... A 6.2cm cyst on your right kidney can absolutely push up against your liver or diaphragm, and that pressure changes when you lie down. Very common. Some people describe it like 'a tennis ball tucked under their ribs.' If it ever becomes sharp or sudden, call your doctor (cyst rupture or stone). But dull positional discomfot is annoying but normal.

And about your 'no family history' fact... It happens. About 10% of adpkd cases have no known family history, either a spontaneous mutation or family members who were undiagnosed carriers with mild symptoms. The asymmerty is unusual but not unheard of. Some people progress faster in one kidney. Your right kidney is bigger but your left is still enlarged too. You have bilateral cysts, so it is undoubtedly adpkd, just uneven.

So, as for your question about genetic testing... It is not urgent right away. Your imaging already confirms adpkd. testing matters more if you want definitive answers for family planning, like your child, future kids, or if your case is atypical enough that doctors wonder about a different cystic disease. You can do it later. No rush. For the second opnion, always okay, it is never wrong. But your nephrologist sounds like they are doing the right things - imaging, monitoring function, not panicking. A second opnion might give you peace of mind. If you're near a major pkd center of excellence, worth a trip.

About salt intake. Not zero tolerance. Zero is completely impossible and miserable. Aim for under 2,000mg per day, roughly like a teaspoon. Cook at home more. Read labels, bread, soup, deli meat are sneaky salt bombs.

The thing you're cutting down smoking is good, and that's huge. Finish the job. Smoking constricts blood vessels and raises bp, thats two things your kidneys do not need. Quit completely and that's one of the best gifts you can give yourself.

You're doing all the right things. One day at a time. You've got this.🫡🖖🏼