Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease, occurring mainly in patients with advanced cirrhosis and ascites, as well as in those with acute liver failure. Despite its functional nature, HRS is associated with a poor prognosis, and the only effective treatment is liver transplantation. A consensus meeting was held to update the definition, diagnostic criteria, and treatment recommendations for HRS. The new definitions emphasize the potential reversibility of HRS, the role of splanchnic vasodilatation, and the frequent role of spontaneous bacterial peritonitis (SBP) as a precipitating factor. The revised diagnostic criteria exclude creatinine clearance and emphasize albumin administration for plasma volume expansion. Treatment of HRS includes vasoconstrictors and albumin, with terlipressin being the most widely used. Albumin infusion is recommended for patients with SBP to reduce HRS incidence and improve survival. TIPS is an alternative treatment for suitable patients, particularly those without a complete response to vasoconstrictors. Extracorporeal albumin dialysis (ECAD) is considered experimental due to its high cost and limited data. Liver transplantation remains the only treatment that ensures long-term survival. The consensus highlights that HRS is characterized by impaired renal function, cardiovascular dysfunction, and overactivity of the sympathetic nervous system and renin-angiotensin system. Type-1 HRS is marked by rapid progression of renal failure, while type-2 HRS involves moderate renal failure with a slower course. The main treatment for HRS is vasoconstrictors combined with albumin, with TIPS and liver transplantation as alternatives. The new consensus provides updated guidelines for the diagnosis and treatment of HRS, emphasizing the importance of early intervention and the role of various therapeutic strategies in improving patient outcomes.Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease, occurring mainly in patients with advanced cirrhosis and ascites, as well as in those with acute liver failure. Despite its functional nature, HRS is associated with a poor prognosis, and the only effective treatment is liver transplantation. A consensus meeting was held to update the definition, diagnostic criteria, and treatment recommendations for HRS. The new definitions emphasize the potential reversibility of HRS, the role of splanchnic vasodilatation, and the frequent role of spontaneous bacterial peritonitis (SBP) as a precipitating factor. The revised diagnostic criteria exclude creatinine clearance and emphasize albumin administration for plasma volume expansion. Treatment of HRS includes vasoconstrictors and albumin, with terlipressin being the most widely used. Albumin infusion is recommended for patients with SBP to reduce HRS incidence and improve survival. TIPS is an alternative treatment for suitable patients, particularly those without a complete response to vasoconstrictors. Extracorporeal albumin dialysis (ECAD) is considered experimental due to its high cost and limited data. Liver transplantation remains the only treatment that ensures long-term survival. The consensus highlights that HRS is characterized by impaired renal function, cardiovascular dysfunction, and overactivity of the sympathetic nervous system and renin-angiotensin system. Type-1 HRS is marked by rapid progression of renal failure, while type-2 HRS involves moderate renal failure with a slower course. The main treatment for HRS is vasoconstrictors combined with albumin, with TIPS and liver transplantation as alternatives. The new consensus provides updated guidelines for the diagnosis and treatment of HRS, emphasizing the importance of early intervention and the role of various therapeutic strategies in improving patient outcomes.