Of the four oral drugs currently used to treat chronic hepatitis B, adefovir may impair renal proximal tubular reabsorption. Tenofovir, which will be marketed, may also affect renal proximal tubular reabsorption. Data published before November 2012 found that 20 cases of severe renal impairment resulting in “Fanconi syndrome” and/or “hypophosphatasia” had been reported in the literature with adefovir for the treatment of chronic hepatitis B. Nineteen of these patients were from Asia. Of these patients, 19 were Asian, 14 were male, and the mean age was 50.6 ± 11.6 years. Prior to the diagnosis of Fanconi syndrome, 16 patients were referred to rheumatology, orthopedics, endocrinology, and nephrology; they had been taking adefovir for a mean of 45.5 ± 25.0 months, with “bone pain” as the first symptom and a significant decrease in blood phosphorus (0.5 ± 0.14 mmol/L). After discontinuation of adefovir, “bone pain” disappeared after only 0.5-4 months, and blood phosphorus normalized after 1-6 months, while alkaline phosphatase could continue to rise after discontinuation of the drug. The majority of patients can recover after stopping the drug. Therefore, when adefovir 10mg/d is used for the treatment of chronic hepatitis B infection, blood phosphorus and blood inosine must be monitored regularly; once the diagnosis is clear, the drug should be discontinued, other antiviral therapy should be switched, and phosphate supplementation should be enhanced, etc. Limited data suggest that the reabsorption function of the renal proximal tubule is well recovered.