Background: Renal dysfunction is a severe complication of advanced cirrhosis as well as of acute-on-chronic liver failure (ACLF). Hepato-renal syndrome (HRS) has been defined as a syndrome that occurs in patients with advanced liver disease, characterised by impaired renal function and marked abnormalities in the arterial circulation and over-activity of the endogenous vasoactive systems. Objective: The aim of this work was to study the role of plasma NGAL level in patients with hepatorenal syndrome in order to identify patients with high risk of renal dysfunction, correlate clinical outcome with therapeutic management and provide a clue on better management to prevent renal deterioration. Patients and methods: This study was carried out on 50 patients. They were divided into 3 groups in addition to control group; group I of 25 patients with decompensated liver cirrhosis , group II of 25 patients with hepato-renal syndrome , group III of 25 hepato-renal patients who followed up after treatment in addition to 25 healthy individuals as a control group ( group IV) . Results: of NGAL in different study groups were as follows: There was a significant increase of NGAL in Group 2 & 3 compared to Group 1& 2. There was a statistical significance between the four groups (p< 0.001). Conclusions: NGAL could be used in conjuction with serum creatinine to assess the hepato-renal affection and may aid in stratifying patients in need for liver transplant.