Hereditary spherocytosis (HS) and hereditary distal renal tubular acidosis (dRTA) could share a common pathogenesis, related to defects in band 3 anion exchanger 1 (AE1), encoded by the human solute carrier family 4 anion exchanger member 1 (SLC4A1) gene. SLC4A1 is expressed both in the red blood cell membrane (eAE1) and in distal tubules of the kidney (kAE1), its mutations may result in red blood cells dysmorphology and impaired urinary acidification. We describe a 7 years-old Italian boy with coexisting HS and dRTA caused by a novel SLC4A1 mutation, confirming that HS and dRTA could be part of a multisystemic disease requiring multidisciplinary approach.