A. Kark

Kidney Health Australia, Melbourne, Victoria, Australia

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Publications (26)

  • GJ Wilson · A Kark · A Mallett · [...] · WE Hoy
    Conference Paper · Oct 2015
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    Gregory Wilson · Adrian Kark · Andrew Mallett · [...] · Wendy Hoy
    [Show abstract] [Hide abstract] ABSTRACT: Background: AKI is a common and important cause of CKD. It remains unknown how AKI severity influences CKD progression. Which co-morbidities influence the progression of CKD also remains undetermined. Methods: We aimed to explore whether AKI severity and patient comorbidities influence CKD progression. Patients with CKD associated with a clinical diagnosis of AKI were identified in the Royal Brisbane & Women’s Hospital cohort (n=1150) of the CKD.QLD registry. AKI events were confirmed through historical creatinine values (2005 onward), and severity determined using AKIN criteria. CKD progression was assessed by change in glomerular filtration rate per year (DeGFR/yr) based on initial and final eGFR(CKD-EPI) values. All co-morbidities identified at the time of enrolment into the registry were explored. Results: 384 patients were recorded as having a primary or secondary AKI diagnosis; 157 of these (99 male, mean age 67yrs) were biochemically confirmed. 133 patients (84.7%) were identified as Stage 1 AKI, 16 (10.2%) as Stage 2 and 8 (5.1%) as Stage 3. A oneway ANOVA revealed that AKI severity did not modulate CKD progression. However, numerically DeGFR/yr was largest for Stage 3 patients (5.1mL/min/1.72m2), and smallest for Stage 1 patients (1.6mL/min/1.72m2). The only two co-morbidities found to influence CKD progression were diabetes mellitus (DM; 35.6% of patients) and peripheral vascular disease (PVD; 12.1% of patients). CKD progression was significantly increased in patients with DM compared with patients without (DeGFR/yr 3.7mL/min/1.72m2, p<0.001), and patients with PVD compared with those without (DeGFR/yr 4.4mL/min/1.72m2, p<0.05). Conclusions: Surprisingly, AKI severity did not alter CKD progression. Both DM and PVD influenced CKD progression in patients with AKI suggesting an increased vulnerability to AKI in these patients.
    Full-text Conference Paper · Oct 2015
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    U Mahmood · A Kark · A Mallett · [...] · WE Hoy
    [Show abstract] [Hide abstract] ABSTRACT: Tailored management of patients with chronic kidney disease (CKD) requires appreciation of the heterogeneity of subjects. Our aim is to describe CKD patients in an Australian public metropolitan renal service, by age.
    Full-text Conference Paper · Sep 2015
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    Gj Wilson · A. Kark · A. Mallett · [...] · We Hoy
    [Show abstract] [Hide abstract] ABSTRACT: Acute Kidney Injury (AKI) has classically been viewed as a benign condition with no long term complications. This paradigm is now under question with mounting evidence suggesting that even acute and relatively mild injury to the kidney may have serious clinical consequences. While observational studies have shown an association between the development of CKD after AKI, the underlying mechanism and the patient factors that potentiate this relationship are not understood. We investigated the features of patients who have AKI associated with CKD in patients enrolled in the Royal Brisbane and Women's Hospital cohort of the CKD.QLD Registry, a state wide registry of patients with CKD.
    Full-text Conference Paper · Sep 2015
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    Anne Cameron (nee Salisbury · U Mahmood · A Kark · [...] · WE Hoy
    [Show abstract] [Hide abstract] ABSTRACT: CKD is an increasing public health problem in Australia and worldwide. About 1.7 million Australians are living with the disease, and management increasingly includes the care of the very elderly. The aim of this report is to characterise elderly patients with CKD in a large metropolitan public renal service in Brisbane, Queensland.
    Full-text Conference Paper · Sep 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Aim: To identify a rare genetic cause for atypical autosomal dominant Fanconi renotubulopathy mimicking Dent’s Disease amongst Australian patients. Background: The HNF4A gene is associated with “Maturity Onset Diabetes of the Young Type 1” however a specific variant has recently been identified causing distinctive autosomal dominant renal tubulopathy. Translation to clinical diagnostic sequencing is desirable. Methods: Two Australian patients with atypical Fanconi renotubulopathy respectively underwent small-pedigree whole exomic sequencing (WES) and diagnostic clinical exome sequencing via the Australian Renal Genetic Disorders Panels (ARGP) at Westmead. Results: Patient 1 presented at 10 years with rickets (requiring multi-level orthopaedic procedures), short stature, asymptomatic low-molecular-weight proteinuria with Fanconi renotubulopathy and progressive chronic kidney disease (CKD). Development was otherwise normal with past history of surgically repaired ventricular septal defect at 5 years. Growth hormone therapy precipitated diabetes mellitus, which resolved upon its cessation. Renal biopsy, imaging and CLCN5/OCRL were normal. Small-pedigree WES identified the de novo p.R76W (NM_000457.4): c.[187C>T];[=]) variant in HNF4A. Patient 2 presented in early childhood with asymptomatic low-molecular-weight proteinuria. She progressively developed Fanconi renotubulopathy, progressive CKD, recurrent morning ketotic hypoglycaemia, hyperaldosteronism, minor osteopenia, subclinical rickets, intermittently raised intraocular pressure, hypermetropia, mild intellectual impairment, generalised joint hypermobility, and pancreatic hyperechogenicity of unknown cause. Renal biopsy, imaging and CLCN5 were normal. ARGP analysis was initially negative, however reanalysis based on recent reports of patients with the p.R76W variant in HNF4A, identified this variant (NM_000457.4):c.[187C>T][=]). Conclusions: These cases reconfirm the association of this heterozygous variant in HNF4A with atypical Fanconi renotubulopathy whilst demonstrating diagnostic translation and integration into the clinical ARGP service for identification of further cases. Further research into the pathogenic mechanism of this variant is required.
    Conference Paper · Sep 2015
  • G. J. Wilson · A. Kark · A. Mallett · [...] · W. E. Hoy
    Article · Sep 2015 · Nephrology
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    [Show abstract] [Hide abstract] ABSTRACT: Background: The Australian Institute of Health and Welfare (AIHW) notes that more than half of all Australians with end stage kidney disease (ESKD) do not receive renal replacement therapy (RRT). These are largely older people, with equal proportions of males and females, unlike the male dominated RRT population in Australia. Little else is known about their characteristics, needs, management and outcomes. We have begun to study these patients through a registry of CKD patients in renal practices in the public health system in Queensland, Australia - CKD.QLD.
    Full-text Conference Paper · Mar 2015
  • A. Allia · R. Koszo · L. Ross · [...] · A. Kark
    Article · Aug 2014 · Nephrology
  • B. Mason · L. Hart · L. Ross · A. Kark
    Article · Aug 2014 · Nephrology
  • Cassandra Rawlings · Rachel Susman · Andrew Mallett · [...] · Adrian Kark
    [Show abstract] [Hide abstract] ABSTRACT: Background: Renal oncocytosis is a rare histopathological finding which can be the precursor for oncocytoma and chromophobe renal cell cancer, usually presenting as bilateral renal nodules. It has been associated with Birt-Hogg-Dubé syndrome, an autosomal dominant disorder characterised by FLCN gene mutations. Case Report: A 68 year old female presented with progressive decline in renal function over 6 months, to CKD stage IV with no physical symptoms. Past medical history included indeterminate inflammatory arthralgia, left lung adenocarcinoma (T1N2; resected 1999 with durable cure), ischemic heart disease, hypertension and Hashimoto's thyroiditis. There was no personal or family history of pneumothorax, renal lesions or kidney disease. Examination was normal with no cutaneous abnormalities. Investigation showed elevated urine protein: creatinine (37 g/mol), inactive urinary sediment and unremarkable renal ultrasound. Renal biopsy demonstrated acute tubulointerstitial nephritis with mild cortical atrophy. There were also clusters of tubules with renal oncocytosis (expansion of tubules by cells with abundant eosinophilic cytoplasm and nuclear atypia on multiple histological levels). Subsequent bilateral renal MRI showed no renal lesions. FLCN gene analysis revealed a previously unreported rare variant of predicted though invalidated pathogenicity. Renal function has recovered somewhat at 6 months of follow up with last serum creatinine 144umol/L (eGFR 21 mL/min/1.73 m2, CKD-EPI). Genetic counselling has been undertaken. Long term renal follow up and annual screening for development of renal lesions is planned in keeping with standard Birt-Hogg-Dubé Syndrome protocols. Conclusions: This case demonstrates the association between renal oncocytosis and a rare FLCN gene variant. Furthermore this may be a new novel mutation responsible for Birt-Hogg-Dubé syndrome, however further validation is required and protocol screening is indicated in the interim.
    Conference Paper · Aug 2014
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    Belinda Mason · Lynda Ross · Emily Gill · [...] · Adrian Kark
    [Show abstract] [Hide abstract] ABSTRACT: The study objective was to develop and evaluate the feasibility and validity of a self-administered Scored Sodium Questionnaire (SSQ) for use in the routine clinical care of Australian chronic kidney disease (CKD) patients. The study took place in community-based outreach clinics using a multidisciplinary model of care. Assessment of sources of dietary sodium intake in the target population used comprehensive diet history interviews (Phase 1) to inform development of a 10-item food frequency questionnaire that was scored and validated using 24-hour urinary sodium and 2 alternative dietary intake methods (Phase 2). Subjects were adults with CKD Stages 3 to 5 (Phase 1 n = 30; Phase 2 n = 47). On a single day, participants completed the SSQ, feasibility survey, 24-hour urine collection, and 24-hour food record. A diet history interview was also conducted to confirm sodium intake on the day of data collection reflected habitual intake. Validity of the SSQ score was confirmed by correlation with 24-hour urine sodium. Validity of a cutpoint on the SSQ score to correctly identify high- versus low-sodium consumers was confirmed by receiver operating characteristic curve analysis: area under the curve, sensitivity, and specificity. Total SSQ score correlated significantly with 24-hour urine sodium (r = 0.371; P = .031). Correlation between 24-hour food record and diet history sodium confirmed consumption on the data collection day reflected habitual intake (r = 0.701; P ≤ .001). A cutpoint of 65 or greater on the SSQ score was confirmed as valid to identify high-sodium consumers: area under the curve 0.713, sensitivity 61%, and specificity 82%. The SSQ is feasible and valid to assess habitual sodium intake in the Australian CKD population and to identify high-sodium consumers for referral to individualized counseling on a low-sodium diet.
    Full-text Article · Jan 2014 · Journal of Renal Nutrition
  • B. Mason · L. Ross · E. Gill · [...] · A. Kark
    Article · Sep 2013 · Nephrology
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    [Show abstract] [Hide abstract] ABSTRACT: Background: Chronic Kidney Disease (CKD) contributes to 10% of deaths and 15% of hospitalisations, mainly for dialysis. Although the most common chronic disease in Australia, CKD data are minimal and reliant on extrapolations from mortality and end stage kidney disease (ESKD) databases. Aim: To describe how CKD populations differ from ESKD populations and the National Mortality Dataset (NMD). Methods: We extracted demographic and kidney disease specific data for the first 740 RBWH patients entered into the CKD.QLD Registry. Patients were registered if they had at least one biomarker of kidney injury for at least 3-months. Data were cross tabulated with the 2010 ANZDATA, a dataset of treated ESKD, and with the 2006 NMD published by the Australian Institute of Health and Welfare (AIHW). The latter records limited kidney disease data. Findings: The CKD population is older than treated ESKD – mean ages of 64.1 vs 59.6 females and 65.8 vs 61.4 years males. The distribution is similar to the AIHW dataset of CKD, including ESKD irrespective of dialysis treatment. Only 1.8% identified as aboriginal. Mean eGFR was 37 mls/min/1.73 m2 (IQR 24.9-51.2). Stage 3 was most common (47.2%), 33.4% stages 4 and 5 and 19.5% stages 1 and 2. Renovascular and renovascular (HTN) were the most common primary renal diseases (27.8%), followed by glomerulonephritis (10.14%) compared to treated ESKD where diabetic nephropathy (38%) was the most common diagnosis and renovascular disease 13%. Primary diagnosis could not be extracted in 31% compared to 5% in treated ESKD. Hypertension and diabetes were comorbidities in 49% and 27.4% in the CKD.QLD dataset. Conclusions: The CKD.QLD Registry is the first practice glimpse into the large CKD population who are not on ESKD treatment. They differ from the latter in several important respects and the longitudinal monitoring functionality of CKD.QKD will greatly supplement information in existing datasets.
    Full-text Conference Paper · May 2013
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    [Show abstract] [Hide abstract] ABSTRACT: Aim: To demonstrate the utility of the CKD.QLD Registry to answer clinical questions. Background: CKD.QLD is a research collaborative studying chronic kidney disease (CKD) patients in the public renal system in Queensland. Funded by Amgen, Queensland Health and the NHRMC, this is the fi rst such systematic study in Australia. Methods: CKD.QLD established a Registry of data recorded during usual care of consenting patients. The fi rst data sampling was with the 1,000th patient consented. 560 were from the Royal Brisbane and Women’s Hospital (RBWH), the fi rst centre to participate. We report preliminary analyses of these data and comparison with external datasets. Results: Of the fi rst 560 RBWH patients, 267 (47.7%) were female with mean (median) ages of 64.1 (68.5) for females and 65.8 (70.1) for males. These are older than patients recorded in ANZDATA 2010 (59.6 and 61.4 yrs respectively). Their age distribution is comparable to those recently described by AIHW in the estimated total incidence of end stage kidney disease in Australia, whether they started renal replacement therapy (RRT) or died with renal failure without RRT. This is the fi rst practice glimpse into the large CKD population who do not receive RRT. Only 1.8% identifi ed as aboriginal. Mean eGFR was 37 mls/ min/1.73 m2 (IQR 24.9–51.2). Stage 3 was the most common (47.2%), 33.4% stages 4 and 5 and 19.5% stages 1 and 2. Renovascular and renovascular (HTN) was the most common primary renal disease (27.8%) and glomerulonephritis was 10.14%. Primary diagnosis could not be extracted in 31%. Hypertension and diabetes were comorbidities in 49% and 27.4%. Conclusions: The CKD.QLD Registry provides characteristics of the CKD patient population in renal care, which greatly supplement information in existing datasets.
    Full-text Conference Paper · Aug 2012
  • [Show abstract] [Hide abstract] ABSTRACT: Calciphylaxis continues to present a clinical challenge for patient management. As in this case, it can be associated with connective tissue disease (CTD) such as systemic lupus erythematosus (SLE). Unlike previous reported cases, long-term remission has been attained. This provides some insight into methods of therapy as well as potential pathogenic models for this disease.
    Article · Oct 2011 · Lupus
  • R. Dahwa · A. Kark · D. Ranganathan
    Article · Sep 2011 · Nephrology
  • R.Dahwa · A.Kark · Ranganathan.D
    Article · Jan 2011 · Nephrology
  • Article · Nov 2010 · The Medical journal of Australia
  • Article · Sep 2010 · Nephrology

Publication Stats

14 Citations

Institutions

  • 2015
    • Kidney Health Australia
      Melbourne, Victoria, Australia
    • University of Queensland
      Brisbane, Queensland, Australia
  • 2012-2013
    • Royal Brisbane Hospital
      Brisbane, Queensland, Australia