Introduction: Diabetic nephropathy is a major microangiopathic complication of type 2 diabetes and a leading cause of chronic kidney disease (CKD). Aim: To improve the diagnostic approach to early diagnosis of diabetic nephropathy in patients with type 2 diabetes mellitus. Materials and methods: One hundred fifty patients were divided into three groups. Group 1 consisted of 67 patients with type 2 diabetes mellitus (DM2) and diabetic nephropathy with stage 1 or 2 of CKD. Group 2 included 45 patients with DM2 without clinical and laboratory evidence for diabetic nephropathy. Group 3 had 38 healthy individuals. The polymorphism of the MTHFR C677T and PAI14G/5G gene was determined by extracted genomic DNA from peripheral blood cells. All patients underwent a real-time PCR reaction. Serum creatinine, MDRD creatinine clearance, albumin/creatinine ratio were examined. Results: The correlation analysis we performed showed a very strong correlation of serum creatinine, creatinine clearance and albumin/ creatinine ratio with the C677T polymorphism of the MTHFR gene and the 4G/5G polymorphism of the PAI-1 gene. We used descriptive statistics, ANOVA, and multiple comparisons; the level of significance was set at p<0.05. Conclusions: 1. The presence of the T allele in the MTHFR gene determines the tendency to increase serum creatinine, decrease creatinine clearance, and increase the albumin/creatinine ratio in morning urine; 2. The presence of 4G allele in the PAI-1 gene determines the tendency to increase serum creatinine, decrease creatinine clearance, and increase the albumin/creatinine ratio in morning urine.

A 27-year-old patient presented with a 3-month history of episodic headaches and persistently rising blood pressure (up to 240/120). The clinical, laboratory, and instrumental findings (episodes of severe hypertension, increased levels of metanephrine in urine, and MRI showing a mass of 5.1&times;5.5 cm in diameter) led us to the diagnosis of pheochromocytoma of the right adrenal grand. Preoperative medication included alpha blockers, calcium channel blockers, and plasma. The right adrenal gland was completely removed using the retroperitoneal access. During the extraction of the tumour, a ventricular tachycardia was recorded after which acute heart failure issued. In the first few hours, echocardiographic imaging showed a reduced EF of 9% &ndash; catecholamine-induced cardiomyopathy. The patient underwent a complex and adequate reanimation in the intensive care unit which lasted 20 days. A slow but steady increase in the ejection fraction along with a decrease in congestion was observed. Magnetic resonance imaging was used to confirm the normalisation of myocardial morphology. A German histological laboratory was used to confirm the benign form of the tumour. For the next three months, the patient was on a standard therapy with beta blockers, angiotensin-converting-enzyme inhibitor and mineralocorticoid&nbsp;antagonists. &#1058;he catecholamine surge during the removal of a large pheochromocytoma could lead to severe cardio-vascular complication, even with a complete and adequate preoperative protective medication. The reversibility of the process implies the necessity of an adequate and timely postoperative treatment for a complete involution of the pathomorphological changes.

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