The cardiorenal syndrome is a relative frequent complication in patients with advanced heart failure (HF) and left ventricular dysfunction. Its presence is associated with a worse prognosis. The pathophysiology of cardiorenal syndrome may vary according to the specific clinical circumstances and conditions of the patients. Thus, the different factors that take part in this syndrome vary among subjects and in the same patient along the time. These mechanisms are multifactorial and many of them are not well defined. These include hemodynamic factors, systemic neurohormonal factors, drug treatment resistances and anemia. The first step in the treatment of cardiorenal syndrome is the optimization of HF therapy that includes diuretics, renin angiotensin system antagonists and beta blockers. However, despite these treatments, the prognosis of this syndrome remains very poor. There has been a growing interest for cardiorenal syndrome in the last years, its pathophysiology and the multiple interactions between heart and kidney. This has made that new therapies for the treatment of this syndrome have been tested, with encouraging results. In this manuscript, the definition, pathophysiology, clinical management and new therapies are reviewed.