Acute kidney injury is a frequently encountered complication in patients with decompensated liver disease. As in the general population, pre-renal, renal and post-renal causes should be excluded, although particular consideration must be given to sepsis and bleeding. Hepatorenal syndrome (HRS) is a type of acute kidney injury found in patients with advanced liver disease, the diagnosis of which should be made only after excluding other causes. Acute and chronic renal dysfunction in cirrhosis is common, and both confer a negative impact on morbidity and mortality.