Introduction The hepatorenal syndrome (HRS) is defined as the development of renal failure in patients with severe liver disease (acute or chronic) in the absence of any other identifiable cause of renal pathology. It is diagnosed following exclusion of other causes of renal failure in patients with liver disease such as hypovolaemia, drug nephrotoxicity, sepsis, or glomerulonephritis. A similar syndrome may also occur in the setting of acute liver failure. ### DIAGNOSTIC CRITERIA The International Ascites Club (1996) group defined the diagnostic criteria for hepatorenal syndrome1 and these are listed in table 1. View this table: Table 1 Major criteria for a diagnosis of hepatorenal syndrome Two patterns of HRS are observed in clinical practice and these were defined by the International Ascites club.1