long term use of tenofovir disoproxil is associated with nephrotoxicity and bone loss. presentation of nephrotoxicity can appear as fanconi syndrome, acute kidney injury, or decline of glomerular filtration rate (gfr). discontinuation of tenofovir disoproxil can potentially lead to reversal of renal impairment. nephrotoxicity may be due to proximal tubules accumulation of tenofovir disoproxil leading to elevated serum concentrations.