Which class of medication is known to cause acute renal failure in patients with bilateral renal stenosis?

ACE inhibitors are known to affect renal blood flow, particularly in patients with pre-existing renal artery stenosis. In cases of bilateral renal artery stenosis, the kidneys rely on angiotensin II to maintain adequate perfusion and glomerular filtration rate (GFR). ACE inhibitors function by reducing the production of angiotensin II, leading to vasodilation of the efferent arterioles in the kidney. This can result in a decrease in glomerular pressure and potential acute renal failure due to diminished perfusion, especially under conditions where renal perfusion is already compromised. Understanding the role of ACE inhibitors in managing blood pressure and their impact on renal function is crucial in clinical settings, especially for patients with underlying kidney conditions.