Hepatorenal syndrome (HRS) is one of common serious complications in patients with severe liver diseases, with a very high mortality rate. The International Ascites Club updated the diagnostic criteria for HRS in 2007, but HRS is still difficult to be diagnosed especially at its early stage because of the lack of specific diagnostic indicators in clinical practice. In recent years, the treatment with vasoconstrictors in association with albumin has been much successful for type I HRS, which has changed the recognition that HRS is an irreversible and untreatable condition by medical management. However, the effect of the drug-therapy is limited, which mainly serves as a bridge for liver transplantation. So far, liver transplantation is the only effective treatment for HRS. With improved understanding of HRS, early prevention of HRS has been considered to be more and more important.