Which medication is most likely to cause nephrotoxicity in a patient treated for chronic hepatitis B?

Adefovir is recognized for its potential to cause nephrotoxicity, particularly as it is often associated with dose-dependent renal impairment. This risk is particularly significant in patients with pre-existing renal dysfunction or those receiving other nephrotoxic agents.

Adefovir is a nucleotide analogue and functions through the inhibition of viral DNA polymerase, much like other antiviral medications for hepatitis B. However, its mechanism of action and metabolism can lead to elevated serum creatinine levels and other signs of renal damage, making diligent monitoring of kidney function essential during treatment.

The other medications listed, such as entecavir, ribavirin, and lamivudine, have a lower incidence of nephrotoxicity. For instance, while lamivudine is also an antiviral agent used for chronic hepatitis B, it has a safer profile concerning renal function compared to adefovir. Entecavir also presents a relatively low risk of nephrotoxicity, and ribavirin is primarily associated with hematologic side effects rather than significant kidney impairment.

In clinical practice, it is crucial to weigh the benefits and risks of medication options in patients with liver disease, particularly considering the potential for renal complications with adefovir. Therefore, careful selection and monitoring of renal function