Liddle's syndrome is an autosomal dominant condition leading towards increased renal tubular (collecting tubule) resorption of Na and in most cases potassium loss. There are classically low renin and aldosterone levels and normal cortisol levels. The cause is increased activity of luminal membrane Na channels. Treatment is with triamterene or amiloride.

Type 4 RTA is caused by a defect in the distal tubule, but it is different from classic distal RTA and proximal RTA because it results in hyperkalaemia rather than hypokalaemia. RTA type 4 is in effect hyporeninaemic hypoaldosteronism.

It occurs when blood levels of aldosterone are low or when the kidneys do not respond to it. Fludrocortisone is usually effective as a form of treatment.

Type IV RTA may result from may result from sickle cell disease, urinary tract obstruction, lupus, amyloidosis, or transplantation