Hemolytic uremic syndrome (HUS) is the most common cause of acute rena
l failure in children and is caused by infection with verotoxin-produc
ing Escherichia coli. There is no consensus on the relative incidence
of HUS in blacks and whites. An equal racial incidence has been report
ed by two centers with small black populations. A series from Washingt
on D. C. reported a low incidence in blacks. The population of Alabama
is 32% black and 66% white. The Children's Hospital of Alabama admiss
ion rate has a similar racial distribution (35% black, 65% white). A r
ecord review from 1980-1992 identified 45 patients with HUS; 43 (96%)
were white and only 2 (4%) were black. Based on census data for Alabam
a in 1980 and 1990, this gives an average annual incidence of HUS of 0
.45 per 100,000 in whites and of 0.043 per 100,000 in blacks (P <0.001
, Fischer's exact test). Similar results were found in the group of pa
tients with HUS and a history of diarrhea; whites 0.39 and blacks 0.02
(P < 0.001). However, in those with no history of diarrhea there was
no significant racial difference: whites 0.05 and blacks 0.02. There w
ere too few blacks to compare clinical course and outcome. We conclude
that typical diarrhea-associated HUS is a relatively rare disease in
blacks compared with whites. The reasons are unclear.