Q: My 20 years old boyfriend is suffering from kidney shrinkage. He was told that both his kidneys have shrunk so he underwent urine and blood tests, which came out all normal. Earlier his calcium levels were very low but now are normal. But now his iron level is low and the doctor has told him that something in his body is over producing. He is on dialysis right now. What causes kidney shrinkage?

A:Advanced kidney disease from most causes can lead to small 'shrunken' kidneys. For his age group, there are a myriad of causes that can lead to kidney disease including congenital anomalies and glomerular diseases like FSGS. Congenital anomalies of kidneys usually present early in life. Did he have frequent urinary infections as a kid? If urine studies are normal, glomerular disease is less likely. There are wide variety of other causes that can lead to kidney disease. At this stage, it may be difficult to find out the exact cause. It is common to see calcium and hemoglobin/iron abnormalities in patients with end stage kidney disease requiring dialysis. There are medications to correct these abnormalities. Please follow up with your nephrologist closely.