摘要慢性乙型肝炎(Chronic hepatitis B, CHB)是一种以肝脏损害为主要表现的感染性疾病，可进展为肝纤维化、肝硬化、肝衰竭或肝癌，危及患者生命。CHB患者易并发乙型肝炎病毒(Hepatitis B virus，HBV)相关性肾小球肾炎，或合并其他肾脏疾病，这类患者的抗病毒治疗需要充分考虑药物的肾脏安全性。根据目前相关指南推荐，合并肾功能不全或者有潜在肾功能损害的患者应优先选用替比夫定、恩替卡韦或丙酚替诺福韦，但这几种抗HBV药物各有利弊，如何在CHB合并肾脏损害的患者中进行抗病毒治疗值得进一步深入探究。同时，抗病毒治疗过程中应定期监测肾功能，以便早期识别肾功能损害。本文就CHB合并肾功能损害的原因，抗HBV治疗引起肾脏损害的风险，抗病毒治疗方案的选择，以及患者肾功能监测等作一综述。

abstractsChronic hepatitis B (CHB) is an infectious disease characterized by liver damage, which can progress to liver fibrosis, cirrhosis, liver failure or liver cancer, threatening the life of patients. CHB patients are prone to be complicated with hepatitis B virus-associated glomerulonephritis and other kidney diseases, therefore the renal safety should be fully considered in the antiviral treatment of CHB patients. According to current guidelines, telbivudine, entecavir or tenofovir alafenamide are recommended for CHB patients with renal insufficiency or potential renal injury, but each has its advantages and disadvantages. How to carry out antiviral treatment in CHB patients with renal impairment deserves our attention. At the same time, the renal function should be monitored regularly in the course of antiviral treatment to identify the damage of renal function in the early stage. This article reviews the causes of renal dysfunction in CHB patients, the risk of kidney damage during the antiviral treatment, the choices of antiviral therapy and the monitoring of renal function in the patients.