Traditionally, the diagnosis of acute renal failure in cirrhosis is made using the conventional criterion of a 50% increase in serumcreatinine (SCr) with the final SCr reaching ≥1.5 mg/dL. The recent recognition that even small increases in SCr irrespective ofthe final SCr level can have a negative impact on survival in cirrhosis has led to refinement of the definition of acute renal failure,or more commonly known as acute kidney injury (AKI) nowadays. The severity of AKI is then defined by different stages. Thusstage 1 AKI represents a small but acute increase in SCr by 0.3 mg/dL or 26.4μmol/L in < 48 hours, or 1.5-2 times increase inSCr from baseline. Stages 2 and 3 AKI represent 2.1-3 times and >3 times of increase in SCr respectively, without a cut-off SCrthreshold. There followed a flurry of studies that used this new definition of AKI and many reported the utility of the new definitionand staging system in predicting prognosis of cirrhotic patients with AKI. However, many were not convinced that this new systemadds any information to what we already know about the prognosis of advanced cirrhosis. In 2 recent articles, which evaluatedthe impact of AKI on short-term mortality in patients with decompensated cirrhosis admitted to the hospital for various reasons,both the new AKI criteria with the conventional criteria for the diagnosis of AKI were applied. The first study reported that patientswith stage 1 AKI and a peak SCr of ≤1.5 mg/dL had a very good survival, similar to that of non-AKI patients. Therefore, a thresholdof SCr of 1.5 mg/dL should be retained in the determination of prognosis for these patients. The second study found that theconventional diagnostic criteria with a cut-off SCr of 1.5 mg/dL was better than the new AKI criteria in the prediction of survival.Furthermore, a SCr of ≥1.5 mg/dL was able to predict progression of AKI. However, a larger study of infected cirrhotic patientsfound that the new AKI diagnostic criteria were accurate in predicting survival. These desperate results therefore fuel an ongoingdebate as to whether the conventional or the new AKI diagnostic criteria are better in the prognostication of these cirrhoticpatients. In advocating for a cut-off SCr of 1.5 mg/dL, there is a concern that treatment for AKI may be delayed till the thresholdis reached. Conversely, if a threshold SCr for the diagnosis of AKI is not set, patients may start expensive pharmacological treatmentfor AKI when it may not be required. Therefore, the International Ascites Club, in setting a compromise, suggested that the newdiagnostic AKI criteria should remain, as there is sufficient evidence to support their application in cirrhosis as accurate. However,pharmacological therapy should not be started until AKI has progressed to at least stage 2. These guidelines will need to be validatedin further studies before they can be generally applied to all cirrhotic patients.