Acute kidney injury (AKI) in patients with cirrhosis is commonly multifactorial. Both diagnosis and management in such cases can be challenging. In many patients, a definitive diagnosis cannot be established through patient history, physical examination, or standard laboratory tests, especially when AKI has a hemodynamic origin, such as hepatorenal syndrome. Current guidelines offer broad recommendations, including stopping diuretics and administering albumin for 48 hours to expand plasma volume. However, these approaches can sometimes be ineffective or even harmful, potentially leading to complications like fluid overload and acute cardiogenic pulmonary edema. Given these limitations, newer diagnostic tools like hemodynamic point-of-care ultrasound (PoCUS) provide a more precise assessment of a patient’s volume status. This technology enables a rapid, noninvasive, and personalized approach to guiding medical treatment.