Hepatorenal Syndrome (HRS) is a serious and life-threatening complication of portal hypertension and end stage liver disease. The cornerstone of treatment is liver transplantation, since renal dysfunction is usually reversible and disappears with the correction of the underlying cause. It is established that HRS has a functional nature and that it is related to renal vasoconstriction. Rapid diagnosis and management are important. Vasoconstrictors together with albumin can ameliorate the effective arterial blood volume and increase renal perfusion pressure. The lack of effective alternative treatment modalities in non responding patients to medical therapy and the almost universally fatal outcome of HRS make transjugular intrahepatic portosystemic stent shunt as a bridge to liver transplantation.