We all know decompensated cirrhotic patients can be critically ill, with a myriad of associated syndromes. Despite this, only on two occasions were syndromes defined by a consensus. In 1978, a conference organized in Sassari, Italy was convened to define and propose diagnostic criteria for hepatorenal syndrome (HRS). After another decade, the 13th International Conference of Gastroenterology in Rome, Italy called for modification of the original criteria.