All affected patients in four families with autosomal dominant familial renal tubular acidosis (dRTA) were heterozygous for mutations in their red cell HCO 3 Ϫ /Cl Ϫ exchanger, band 3 ( AE1, SLC4A1 ) genes, and these mutations were not found in any of the nine normal family members studied. The mutation Arg 589 → His was present in two families, while Arg 589 → Cys and Ser 613 → Phe changes were found in the other families. Linkage studies confirmed the co-segregation of the disease with a genetic marker close to AE1 . The affected individuals with the Arg 589 mutations had reduced red cell sulfate transport and altered glycosylation of the red cell band 3 N-glycan chain. The red cells of individuals with the Ser 613 → Phe mutation had markedly increased red cell sulfate transport but almost normal red cell iodide transport. The erythroid and kidney isoforms of the mutant band 3 proteins were expressed in Xenopus oocytes and all showed significant chloride transport activity. We conclude that dominantly inherited dRTA is associated with mutations in band 3; but both the disease and its autosomal dominant inheritance are not related simply to the anion transport activity of the mutant proteins. ( J. Clin. Invest. 1997.