A review of extrarenal involvement in diarrhoea-associated haemolytic-uraemic syndrome (HUS) is based on 64 of our autopsied patients and an update of the literature. Large bowel pathology was the commonest (29 cases), followed by the central nervous system (21 cases), the heart (19 cases) and the pancreas (19 cases). The severity of systemic involvement was associated with the magnitude of renal compromise and the prognosis of the acute phase. Diarrhoea-associated HUS is described as a multiorgan entity, due to extensive microvascular damage and thrombosis. At present mortality during the acute phase is not confined to renal failure; systemic involvement can also lead to death.