Understanding Epithelial Cells in Urine

Epithelial cells are found in urine, as they are part of the epithelium that lines the urinary tract and periodically exfoliates. However, an epithelial cell count that is highly elevated over the normal range may indicate some form of health issue. 

Through a simple urinalysis, these cells can be identified and analysed for infections, kidney problems, and other disorders. 

What Are Epithelial Cells?  

Epithelial cells are thin and flat in structure, covering the surfaces of various body parts, such as the urinary tract, kidneys, bladder, and so on.  

These cells protect underlying tissues from the damaging effects of toxins, bacteria, and other harmful materials. Epithelial cells play various functions, such as absorption, secretion, and even system filtration.  

Epithelial cells are essential in relation to urinary health, as different kinds of epithelia with different origins are distinguished in every urine sample.  

Types of Epithelial Cells Found in Urine 

Squamous, Transitional and Renal Tubular Epithelial Cells are examples of the three types of epithelial cells found in urine.  

There are three types of epithelia in total for each tissue of different regions of the urinary system. Recognising these cells is important as they provide meaningful diagnostic information. 

Squamous Epithelial Cells 

The most important type is squamous epithelial cells, which originate from the urethra or the external genital area. A small number of these cells is normal, but a larger quantity may indicate contamination of the sample or inflammation of the urinary tract. The shape of these cells is flat and irregular, allowing easy identification under the microscope. 

An excess of squamous cells in urine may be due to improper collection methods, for example, if the sample was not collected in the centre of the flow. Although their presence is generally not a cause for concern, an abnormally high quantity that is constantly observed is a problem that requires further investigation. 

Transitional Epithelial Cells 

These epithelial cells are from the bladder, ureters, or renal pelvis. A few transitional epithelial cells in the urine are normal, but increased levels may indicate infection, bladder irritation, or bladder cancer in rare cases. These cells tend to be smaller and rounder than the squamous ones, and they may be seen in groups. 

Inflammation, bladder infections and some medical treatments that affect the urinary tract can increase the number of transitional epithelial cells. Their presence may indicate a more serious condition that requires additional diagnostic tests. 

Renal Tubular Epithelial Cells 

These cells are the most clinically important because they are shed from the kidney tubules. An increased amount may suggest damage to the kidneys, infections, or diseases like acute tubular necrosis. The renal tubular epithelial cells are the smaller, rounder type of cell compared to the other two types and are more frequently related to kidney disorders. 

An increased number of renal tubule epithelial cells in the urine should be examined immediately by a doctor, as it indicates significant kidney damage. Recognising and treating the disease is essential to avoid further complications. 

Normal Range of Epithelial Cells in Urine 

A urine test usually reveals 0–5 epithelial cells per high-power field (HPF), which is considered normal. Any increase above this threshold is cause for concern. The normal range is subject to individual variation depending on fluid intake, sample collection and general well-being. 

Common Levels of Epithelial Cells in Urine 

Typical Levels of Epithelial Cells in Urine 

• 0–5 cells per HPF: Normal range. 
• 6-10 cells per HPF: Increased count may indicate slight irritation or contamination. 
• More than 10 cells per HPF: A marked increase suggests infection, renal disease, or other ailments. 
• Persistently elevated levels: Further investigation is needed to identify the underlying reason. 

High Epithelial Cell Counts: Signs of Potential Health Issues 

 An increase in epithelial cells in the urine may be due to reasons like: 

1. Urinary tract infections (UTIs) 

2. Kidney diseases 

3. Inflammation or irritation in the urinary tract 

4. Sample contamination from improper collection 

5. Bladder or kidney disorders 

6. Chronic conditions such as diabetes affecting kidney function 

Surpassing the epithelial cell threshold may indicate an infection, a kidney ailment, contamination of the sample, an underlying medical condition, or being with a child. It is critical to figure out the reason to decide the proper treatment. 

Causes of Elevated Epithelial Cells in Urine 

Elevated epithelial cells in urine may indicate infection, inflammation, kidney disease, or contamination from the urinary tract. Common causes include UTIs, kidney conditions, or improper sample collection. 

Urinary Tract Infections (UTIs) 

This type of infection is widespread and leads to an increase in epithelial cells in the urine due to irritation in the bladder and urethra. Other symptoms include pain when urinating, frequent visits to the toilet and cloudy urine. Urinary tract infections can be found in all age groups and are often diagnosed in women due to their anatomy. 

Kidney Diseases 

Diseases that damage the kidneys, such as inflammation and chronic and slowly progressive kidney disease, can lead to a proliferation of renal tubular epithelial cells, signalling kidney impairment or dysfunction. It is important to recognise people with impairment earlier and treat them in time to avoid complications. 

Sample Contamination 

Improper or non-sterile collection of a urine sample can lead to external contamination of the squamous epithelial cells in the sample. Strict hygiene protocols must be followed to ensure the quality of the test results. 

Medical Conditions 

Some bladder conditions, such as diabetes and autoimmune diseases, can lead to an increase in epithelial cells in the urine. These may require long-term treatment by a doctor. 

Pregnancy 

Elevated urinary epithelial cell levels can occur due to hormonal changes during pregnancy. Proper and regular monitoring will ensure that any underlying infections or complications are detected at an early stage. Urinalysis is essential for prenatal examinations in order to be able to make an early diagnosis in emergencies. 

What are the risk factors for increased epithelial cells? 

• Failure to maintain good hygiene results in infections. 
• Chronic Diabetes or kidney disease. 
• Inflammation or infection of the bladder. 
• Concentrated urine due to dehydration. 
• Bladder sample collection error. 
• Hormonal changes in pregnancy. 

Diagnostic Approaches and Testing Methods 

In a urinalysis, the epithelial cells in the urine are analysed as part of the test. This test is used to analyse urine in order to diagnose infections, examine the kidneys and assess various other diseases. Other methods that a doctor can use for diagnosis include 

• Microscopic analysis: determines the type and number of epithelial cells present. 
• Urinalysis: Determines the presence of pathogenic bacteria in the urinary system. 
• Blood test: Determines creatine and BUN levels to assess the person’s kidney function. 
• Imaging: An ultrasound or CT scan helps diagnose structural abnormalities. 

A proper diagnosis will ensure that the person receives the necessary treatment to treat the underlying disorder. 

Treatment Options for Elevated Epithelial Cells in Urine 

Treatment will depend on the underlying problems and can include medication, dietary or lifestyle changes. 

Medical Treatment for Infections and Underlying Conditions 

• Use of antibiotics to treat bacterial infections such as urinary tract infections 
• Medication for the treatment of inflammatory kidney disease 
• Hydration therapy to support the elimination of waste products 

Dietary Changes for Improved Kidney and Urinary Health 

• Drinking plenty of water to keep the urinary tract free from infection 
• Limiting sodium intake reduces the burden on the kidneys 
• Eating foods high in antioxidants, such as berries and vegetables, especially greens 
• Keeping protein intake to a minimum to reduce the burden on the kidneys  

Lifestyle Modifications for Recovery and Prevention 

• Good personal hygiene to reduce the occurrence of infections 
• Avoiding smoking and excessive alcohol consumption 
• Regular physical activity to improve kidney function 
• Effective management of chronic diseases such as diabetes. 

When to Consult a Healthcare Professional 

• Recurrent, frequent UTIs that do not go away easily   
• Change in colour, smell, or consistency of urine in unusual manners   
• Pain while urinating or pain in the lower abdomen   
• Kidney problem signs which include swelling or fatigue   
• Urine, or abnormal test results, containing blood alongside other abnormalities   

Why Choose Cadabam's Diagnostics for Your Urinary Health? 

At Cadabam’s Diagnostics, we offer advanced urinalysis, precise diagnostic methods and expert medical advice. Our specialists have extensive healthcare experience and ensure accurate assessment and personalised treatment based on the findings. We emphasise timely, patient-centred care and provide ongoing services to support long-term health. 

Book a test today!