What is the association of acute renal failure, angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker in a young patient?

A 13-year-old girl was admitted to the hospital with unconsciousness and oliguria. She had also suffered from vomiting and weakness for 7 days. Her medical history was remarkable for delay in motor skills and mental retardation. No other investigation was performed until 2 months previously when she visited another clinic for complaints of palpitation, fatigue and sweating. For hypertension and obesity, treatment with ramipril and losartan plus hydrochlorothiazide was started. She was confused and mildly dehydrated; blood pressure, 97/50 mmHg; pulse, 97/min. She was an overweight child with a body mass index of 28 kg/m. Serum urea nitrogen 135 mg/dL (48.18 mmol/L), creatinine 7.2 mg/dL (636.48 μmol/L) and uric acid 13.3 mg/dL (791.08 μmol/L) were high and other biochemical parameters with urinalysis were normal. Her urine output was 250 mL in the previous 24 h. All medications were stopped, and she was followed with appropriate intravenous fluid. On the fifth day, the renal function test and the urine output were normal. After recovery of renal function completely, severe hypertension occurred within several days, and the mean systolic and diastolic pressure, without significant differences between the lower and upper extremities, were 180 and 120 mmHg. All biochemical markers, electrolytes, plasma catecholamines, cortisol and thyroid hormones, serum renin activity, aldosterone, serum complements, anti-ds-DNA, ANA and vanillylmandelic acid in 24-h urine and abdominal/renal Doppler ultrasonography were normal. An echocardiography showed mild left ventricle hypertrophy without coarctation. Grade 2 hypertensive retinopathy was documented by fundoscopic examination. She was very endearing, friendly, loquacious and empathetic associated with her typical facial features (Figure 1). Question