The hemolytic-uremic syndrome (HUS) has been recognized as a cause of acute renal failure in infancy and childhood since 1955.1 The syndrome is characterized by a diarrheal prodrome, microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Numerous articles from both endemic2.3 and nonendemic4.5 regions have reported the broad spectrum of severity of this disease. However, relatively little emphasis has been given to the tendency of this disorder to occur in siblings. This article reports HUS in two brothers from a nonendemic area and demonstrates the variations in severity of this disease.
Report of Cases.—Case 1.—A 4-year-old boy was admitted to Henrietta Egleston Hospital for Children, Atlanta, after bloody diarrhea, vomiting, and increasing lethargy of five days' duration. Bloodtinged urine had developed the day prior to admission. Physical examination showed a lethargic but easily aroused child. The blood pressure (BP) was 96/62 mm Hg. The conjunctivae were mildly