Secondary type 1 RTA may result from drugs, kidney transplantation, or various disorders: Autoimmune disease with hypergammaglobulinemia, particularly Sjögren syndrome or rheumatoid arthritis Kidney transplantation Nephrocalcinosis Medullary sponge kidney Chronic obstructive uropathy Drugs (mainly amphotericin B, ifosfamide, and lithium) Cirrhosis Sickle cell anemia Potassium level may be high in patients with chronic obstructive uropathy or sickle cell anemia.