Hepatorenal syndrome is a well characterized entity in which vasodilation of splanchnic vessels and intense constriction of the renal cortical vasculature occur in concert. The condition is often fatal unless orthotopic liver transplantation (OLT) is performed. Many extracorporeal blood purification techniques exist which can be offered to patients awaiting OLT. Continuous hemofiltration, with or without other modalities such as therapeutic plasma exchange and hemoperfusion, may be helpful in improving the level of consciousness of these patients. Unfortunately, mortality and hepatic regeneration do not appear to be affected by such interventions. The development of a hybrid bioartifical liver support system and pharmacologic manipulation of the hemodynamic perturbations that occur in HRS provide particularly appealing prospects as a means of providing a bridge to liver transplantation in the future.