Summary. Background: The pathogenesis of Shiga toxin (Stx)‐mediated childhood hemolytic uremic syndrome (HUS) is not fully delineated, although current evidence implicates a prothrombotic state. We hypothesized that the tissue factor (TF) pathway plays a major role in the pathophysiology of HUS. Materials and methods: We measured cell surface TF activity in response to tumor necrosis factor‐α (TNF‐α) (20 ng mL−1, 2–144 h), Stx‐1 (10−11 mol L−1, 4–144 h), or their combination (TNF‐α 22 h and Stx‐1 for the last 0.5–4 h of TNF‐α incubation) on human glomerular (microvascular) endothelial cells (HGECs) and human umbilical vein (macrovascular) endothelial cells (HUVECs). Results and conclusions: We observed that while TNF‐α caused an increase in cell surface TF activity on both cell types, the combination of TNF‐α and Stx‐1 differentially affected HGECs. On these cells, TF activity was increased further by 2.67 ± 0.38‐fold (n = 38, P < 0.001), consistent with our parallel observation that Stx‐1 binds to HGECs but not to HUVECs. Anti‐TF antibody abolished functional TF while anti‐tissue factor pathway inhibitor antibody enhanced TF activity. Stx‐1 alone did not induce TF activity on either cell type. Measurement of TF antigen levels and quantitative real‐time polymerase chain reaction demonstrated that exposure to TNF‐α markedly increased TF protein and TF mRNA for HGECs, but the exposure to the combination of TNF‐α and Stx‐1 did not increase further the amount of either TF protein or TF mRNA. We conclude that cytokine‐activated HGECs, but not HUVECs, undergo a significant augmentation of cell surface TF activity following exposure to Stx, suggesting an important role for TF in the coagulopathy observed in HUS.