Functional renal failure without renal pathology; occurs in 10% of pts with advanced cirrhosis or acute liver failure. Thought to result from altered renal hemodynamics. Two types: type 1 HRS—decrease in renal function within 1-2 weeks of presentation; type 2 HRS—associated with a rise in serum creatinine but is associated with a better outcome. Often seen in pts with refractory ascites. Treatment: midodrine along with octreotide and IV albumin. For either type 1 or 2 HRS, prognosis is poor in the absence of liver transplantation.