Objective To investigate the effect of tiopronin on renal function during anti?tuberculosis liver protection therapy. Methods Clinical data of patients with initially treated sensitive tuberculosis treated in our hospital from September 2019 to September 2022 and whose anti?tuberculosis regimen was only isoniazid， rifampicin， pyrazinamide and ethambutol were retrospectively analyzed. The patients were divided into study group and control group according to whether tiopronin was used. The baseline data， blood creatinine （Scr）， blood urea nitrogen （BUN）， urine protein， creatinine clearance， drug combination and related adverse reactions of the two groups were compared. Results Patients obtained based on inclusion and exclusion criteria were divided into a study group （n = 102） （antitubercular drugs + tiopronin） and a control group （n = 105） （antitubercular drugs + glutathione）. There were no statistically significant differences （P > 0.05） in ALT， AST， DBIL， and TBIL levels between the two groups before treatment， at Middle and late treatment. At the later stage of treatment， serum Scr， BUN， creatinine clearance and urinary protein showed statistical differences between the study group and the control group （P < 0.05）. The abnormal rate of indicators and the incidence of adverse reactions in the study group were higher than those in the control group at the later stage of treatment （P < 0.05）. Conclusion For patients undergoing tuberculosis treatment， the efficacy of tiopronin and glutathione in protecting the liver is comparable. However， in terms of renal function， long?term use of tiopronin is associated with more pronounced damage. Due to the relatively low cost of tiopronin， for families with heavy economic burdens， short?term use of the drug can ensure safety， while long?term use requires close monitoring of renal function changes and timely adjustments to medication.