<s>[INST] Hello sir. I have been diagnosed with ckd. My doctor told me that my kidneys are highly echogenic and my left kidney appear small in size. During dtpa, they found that my net gfr is 56 and split is 18 for left and 37 for right kidney. But I don t know the underlying cause for my kidney damage. Doc said no biopsy. [/INST] Hi, welcome to Chat Doctor. Looking to your history, it seems that you have Chronic kidney disease stage 3 with shrunken kidney. Biopsy is a diagnostic procedure to determine the cause of kidney dysfunction. But, biopsy can not be performed on shrunken kidney. It will not give us any answer. Check basic urine report, 24 hour urine protein and BP. These can give us some clue about type of your kidney disease.Don't worry. Consult your nearby Nephrologist or you can communicate with me also with reports. I think this would be helpful to you. Best wishes. TC. Chat Doctor.  </s>