The hepatorenal syndrome is defined as renal failure in patients with severe liver disease. It may be diagnosed by exclusion of other potential factors which may cause renal failure, such as hypovolaemia, nephrotoxic drugs and severe bacterial infection. Liver transplantation is the target treatment leading to recovery of renal function. Other methods such as vasoconstrictors, renal replacement therapy and repeated paracenthesis with intravenous albumin infusions are also presented.