Which condition often has a late onset, potentially not causing symptoms until the fourth decade of life?

Adult polycystic kidney disease (APKD) is a genetic disorder that often remains asymptomatic until later in life, typically not presenting symptoms until the fourth decade. This delayed onset is primarily due to the gradual accumulation of cysts within the kidneys, which can expand over many years, leading to renal dysfunction only as the number and size of the cysts increase significantly.

In contrast, conditions like acute tubular necrosis usually have a fairly rapid onset related to acute injury or insult to the kidneys, and infantile polycystic kidney disease manifests much earlier, often in infancy or childhood, due to its genetic nature. Chronic kidney disease can present with varying degrees of symptoms depending on the underlying cause and stage, but it also does not specifically correspond to a late onset that directly aligns with the timeframe associated with APKD. Thus, the characteristic of adult polycystic kidney disease, with its late manifestation and symptom development, makes it the relevant choice.