SLC26A4 and distal renal tubular acidosis: We established the diagnosis of pSS based on ACR-EULAR criteria for the diagnosis of Sjogren syndrome.7 Under-expression of H(+)-ATPase and pendrin is thought to be the main mechanism of distal renal tubular acidosis in patients with SS.8 Usually dRTA is mild in pSS but can be severe in some patients.