Hepatorenal syndrome (HRS) is a severe complication of end-stage liver disease, primarily affecting patients with advanced cirrhosis and ascites, characterized by marked circulatory dysfunction. Despite its poor prognosis, liver transplantation remains the only effective treatment. The International Ascites Club held a Focused Study Group to update the definition, diagnostic criteria, and treatment recommendations for HRS. New concepts include the dominance of splanchnic vasodilation, the role of cardiac output, and the importance of bacterial infections as triggers. Treatment options include vasoconstrictors, albumin, transjugular intrahepatic portosystemic stent-shunt (TIPS), and extracorporeal albumin dialysis (ECAD). Vasoconstrictors and albumin are effective for type-1 HRS, while TIPS can improve renal function and ascites in type-2 HRS. ECAD is experimental and costly. Liver transplantation is the preferred treatment for both types of HRS, but pre-transplant pharmacological treatment can improve survival. The consensus provides updated definitions, diagnostic criteria, and treatment recommendations to guide clinical practice.Hepatorenal syndrome (HRS) is a severe complication of end-stage liver disease, primarily affecting patients with advanced cirrhosis and ascites, characterized by marked circulatory dysfunction. Despite its poor prognosis, liver transplantation remains the only effective treatment. The International Ascites Club held a Focused Study Group to update the definition, diagnostic criteria, and treatment recommendations for HRS. New concepts include the dominance of splanchnic vasodilation, the role of cardiac output, and the importance of bacterial infections as triggers. Treatment options include vasoconstrictors, albumin, transjugular intrahepatic portosystemic stent-shunt (TIPS), and extracorporeal albumin dialysis (ECAD). Vasoconstrictors and albumin are effective for type-1 HRS, while TIPS can improve renal function and ascites in type-2 HRS. ECAD is experimental and costly. Liver transplantation is the preferred treatment for both types of HRS, but pre-transplant pharmacological treatment can improve survival. The consensus provides updated definitions, diagnostic criteria, and treatment recommendations to guide clinical practice.