Background: Hepatorenal syndrome (HRS) is a kidney function defect that happens in severe chronic liver disorder, particularly in cases of liver cirrhosis. Angiotensin II type I receptor (AT1R) has been associated with liver steatosis and fibrosis. This study intended to investigate a distribution of AT1R gene polymorphism in patients with HRS and the association between its genotypes and the prognosis of HRS. Moreover, this study assesses the polymorphism of AT1R gene as a risk factor and a predictor of HRS. Patients and methods: This study was carried out on 50 HRS patients with cirrhosis of the liver beside 50 healthy subjects acted as controls to evaluate AT1R (A1166C) gene polymorphism using Real-Time PCR. Results: AT1R genotypes distributions showed significant differences between HRS patients and controls as the mutant genotype CC (6%) and hetero genotype AC (24%) were more significant in HRS patients than controls (0% and 12%; respectively) with P value <0.01, hence there was a relationship between the HRS progression and AT1R genotypes. On the other hand, there were no statistically significance differences between alleles frequencies in patients and controls (P>0.05) as their frequencies were 96% for allele A and 4% for allele C in patients compared to 90% allele A and 10% allele C in controls. Furthermore, there was a relation between the genotypes of AT1R gene and creatinine clearance and the mean arterial pressure (MAP) in HRS patients. Conclusion: There was a link between AT1R gene polymorphism and the risk of developing HRS. In addition, the relationship between AT1R genotypes and creatinine clearance could be also used as a predictor of HRS progression.