Clinical Case Presentation 1 A 34-year-old woman presents with diffuse muscle weakness over several days. She also reports dry eyes and dry mouth over the last several months. Laboratory analysis shows the following: Na+ 141 mmol/L, K+ 2.5 mmol/L, Cl– 112 mmol/L, and HCO3– 16 mmol/L, and an arterial blood gas test shows pH 7.32 and pCO2 31 mmHg. Serum creatinine is 1.4 mg/dL and urine pH is 6.8. Ultrasound imaging shows normal sized kidneys with evidence of numerous calcifications distributed throughout both kidneys. The patient is diagnosed with type 1 RTA, thought to be secondary to underlying Sjögren’s syndrome.