A urine test is a commonly used diagnostic tool to assess kidney function and detect potential infections or health conditions. One important parameter in urinalysis is the presence of epithelial cells, which are naturally shed from the urinary tract. While a small number of these cells is considered normal, an elevated count may indicate underlying issues such as infections, inflammation, or kidney disorders. In this article, we’ll explore the different types of epithelial cells in the urine, their normal range, possible causes of increased levels, and what your test results could mean for your health.

What are Epithelial Cells and What are their Functions?

Epithelial cells are a type of cell that line the surfaces of the body, including the urinary tract, bladder, and kidneys. These cells naturally shed into the urine as part of the body’s normal renewal process. However, their presence in a urine sample can vary based on health conditions. Functions of epithelial cells in the urinary system:

• Barrier Protection: They form a protective lining that prevents harmful substances and pathogens from entering deeper tissues.
• Filtration and Absorption: Certain epithelial cells in the kidneys help filter waste and reabsorb essential nutrients.
• Regeneration: They contribute to the renewal of the urinary tract lining, ensuring proper function.

The presence of occasional epithelial cells in urine is normal, but an increased number could signal an infection, inflammation, or kidney-related conditions. Understanding the different types of epithelial cells in urine is crucial for interpreting test results.

Types of Epithelial Cells in Urine

Epithelial cells found in urine are classified into three main types, each originating from a different part of the urinary system. The type and number of these cells help determine potential health concerns.

• Squamous Epithelial Cells

• These are large, flat cells that come from the lower urinary tract, including the urethra and vagina.
• A few squamous cells in urine are normal, but high amounts may indicate contamination of the sample, especially in females.

• Transitional Epithelial Cells (Urothelial Cells)

• Found in the bladder, ureters, and renal pelvis, these cells line the urinary tract.
• These cells are more commonly seen in the urine of older adults. 
• Moderate or high levels may suggest conditions like a urinary tract infection (UTI) or bladder irritation.

• Renal (Kidney) Epithelial Cells

• These originate from the kidneys and are the most clinically significant.
• Increased kidney epithelial cells in urine may indicate kidney disease, infection, or damage to the renal tubules.

Who Might Need a Urine Test for Epithelial Cell Count?

Doctors recommend this test when patients show symptoms of urinary issues or kidney disorders, or as part of routine health checkups. It helps in early diagnosis and effective treatment of various medical conditions.

1. Patients with Symptoms of Urinary Tract Infection (UTI)

• Burning sensation while urinating
• Frequent urination
• Cloudy or foul-smelling urine
• Pelvic pain

2. Individuals with Suspected Kidney Disease

• Swelling in the legs or face
• High blood pressure
• Foamy urine (indicating protein leakage)

3. People with Blood in the Urine (Hematuria)

• Can indicate kidney stones, infections, or bladder issues
• Further tests like a urine culture or imaging may be required

4. Routine Health Checkups

• Some doctors recommend urine tests as part of annual health screenings, especially for those with diabetes, hypertension, or a history of kidney disease.

5. Pregnant Women

• Regular urine tests help monitor kidney function and detect infections or preeclampsia risks.

6. Patients on Long-Term Medication

• Certain drugs, such as pain relievers or antibiotics, can affect kidney function and require periodic urine analysis.

How is Epithelial Cell Count Measured?

The detection of epithelial cells in urine is part of a urinalysis, a common diagnostic test used to assess kidney and urinary tract health. The test is simple, non-invasive, and typically conducted as follows:

1. Sample Collection:
• A clean catch method is used to collect midstream urine samples in a sterile container to minimise contamination. The patient is asked to clean the genital area with a sterile wipe or soap and water. They should urinate a small amount into the toilet bowl, pause, collect urine in the cup, and then finish urinating into the toilet bowl. 
• In some cases, a catheter urine sample may be taken for more accurate results.
2. Microscopic Examination:
• The urine sample undergoes microscopic analysis to count and identify the types and count of epithelial cells.
• A dipstick test may also be performed to check for abnormalities such as protein, blood, or leukocytes in the urine.
3. Results Interpretation:
• Epithelial cell count is reported as ‘few’, ‘moderate’, or ‘many’
• The presence of a few epithelial cells is normal.
• Moderate or many cells may indicate infection, inflammation, kidney disease, liver disease, cancer, or contamination of the sample.

Normal Range of Epithelial Cells in Urine Test

The presence of epithelial cells in urine is common, but the quantity helps determine whether it's within a normal range or a sign of an underlying issue.

• Normal Range of Squamous Epithelial Cells: 0–5 cells per high power field (HPF)
• Normal Range of Transitional Epithelial Cells: 0-3 cells per high power field (HPF)
• Normal Range of Renal Tubular Epithelial Cells: 0-2 cells per high power field (HPF)
• Moderate cell count (6–15/HPF): May indicate minor contamination or mild irritation.
• Many cell counts (>15/HPF): Could suggest an infection, kidney disease, or other urinary tract issues.

Different types of epithelial cells (squamous, transitional, or renal) also impact interpretation. A higher number of renal epithelial cells is more concerning as it may indicate kidney damage.

Relationship Between Red Blood Cells, Pus Cells, and Epithelial Cells in the Urine Microscopic Examination

Epithelial cells, red blood cells (RBCs), and pus cells (white blood cells/WBCs) are analysed together in a urine microscopic examination to assess overall urinary tract health. Their combined presence helps doctors diagnose infections, kidney conditions, or other urinary system disorders.

Why Are They Analysed Together?

• Urinary Tract Infections (UTIs): High pus cells (WBCs) and bacteria indicate infection, often accompanied by epithelial cells.
• Kidney or Bladder Issues: Increased RBCs may suggest bleeding from kidney stones, infections, or trauma.
• Contamination vs. Pathology: A mix of squamous epithelial cells and bacteria may indicate an unclean sample rather than a disease.

Red Blood Cells (RBCs) in Urine: Normal Range and Significance

Normal Range: 0-3 RBCs per high power field (HPF)

• A small number of Red Blood Cells in urine is normal. However, higher levels may indicate infections, kidney disease, or urinary tract injuries.

Pus Cells in Urine: Normal Range and Meaning

Normal Range: 0-5 pus cells per HPF

• Elevated pus cells (white blood cells) in urine suggest an infection or inflammation in the urinary tract, bladder, or kidneys. Infections like UTIs are the most common cause.

Increased Epithelial Cells in the Urine: Symptoms, Causes, and Implications

An elevated number of epithelial cells in urine can indicate an underlying health condition. While a mild increase may not be concerning, persistently high levels could signal infections, kidney disease, or other issues.

Symptoms of Increased Epithelial Cells in Urine

• Urinary changes: Cloudy, dark, or foul-smelling urine
• Frequent urination: Increased urge to urinate, sometimes with discomfort
• Pain or discomfort: Burning sensation during urination or lower abdominal pain
• Blood in urine: Visible or microscopic hematuria
• Swelling: In cases of kidney-related issues, swelling in the hands, feet, or face may occur

Causes of Increased Epithelial Cells in Urine

• Urinary Tract Infections (UTIs): Infections can cause epithelial shedding into the urine
• Kidney Disease: Conditions like nephritis or kidney injury can increase renal epithelial cells
• Inflammation: Bladder or urethral inflammation (cystitis or urethritis)
• Contamination: Improper sample collection may lead to an increased count
• Pregnancy: Hormonal changes can result in a slight increase in epithelial cells

Implications of High Epithelial Cells in Urine

A consistently high or many epithelial cell count requires further urine analysis and medical evaluation to determine the root cause. Identifying whether squamous, transitional, or renal epithelial cells are predominant helps guide diagnosis and treatment.

Treatments for Abnormal Levels of Epithelial Cells in the Urine

The treatment for increased epithelial cells in urine depends on the underlying cause. If the abnormal levels are due to an infection, kidney disease, or other medical conditions, addressing the root issue is key to restoring normal urine composition.

1. Treating Urinary Tract Infections (UTIs)

• Antibiotics: Prescribed based on urine culture results to eliminate bacterial infection
• Increased Fluid Intake: Drinking plenty of water helps flush out bacteria from the urinary tract
• Probiotics & Cranberry Supplements: May help prevent recurrent infections.

2. Managing Kidney Disease or Inflammation

• Medications: Depending on the cause, diuretics, anti-inflammatory drugs, or immunosuppressants may be needed
• Dietary Changes: Reducing salt, protein, and processed foods helps ease kidney strain
• Regular Monitoring: Frequent urine and blood tests to assess kidney function

3. Addressing Bladder or Urethral Irritation

• Avoiding Irritants: Reducing caffeine, alcohol, and spicy foods can help soothe irritation
• Hydration: Staying hydrated dilutes urine and reduces bladder inflammation
• Pelvic Health Therapy: In some cases, physical therapy may help with chronic inflammation

4. Improving Hygiene & Preventing Contamination

• Proper Urine Sample Collection: Using a clean-catch method prevents misleading test results
• Personal Hygiene: Maintaining good hygiene helps prevent infections and irritation

5. Pregnancy-Related Cases

• Routine Monitoring: Increased epithelial cells in urine during pregnancy are often normal but should be monitored
• Balanced Nutrition & Hydration: Eating a well-balanced diet and staying hydrated supports urinary health

If abnormal epithelial cell levels persist, further diagnostic tests may be needed, such as urine culture, imaging tests, or kidney function assessments. Consulting a doctor ensures the right treatment plan is followed.

Conclusion

The presence of epithelial cells in urine is usually normal, but higher levels may indicate infections, kidney conditions, or other underlying health concerns. Regular urine tests can help detect abnormalities early and guide timely medical intervention.

For convenient and reliable health monitoring, consider MaxAtHome’s at-home urine test services. With easy sample collection and expert analysis, you can get accurate results from the comfort of your home. Take control of your health—book your urine test with MaxAtHome today! Call us at 01244781023 or email homecare@maxhealthcare.com for bookings and enquiries.

Frequently Asked Questions

• What is the normal range of epithelial cells in urine?

A normal urine test typically shows few epithelial cells (0–5 per high power field, HPF). Higher counts may require further evaluation.

• What causes increased epithelial cells in urine?

Common causes include urinary tract infections (UTIs), kidney disease, bladder inflammation, and improper sample collection.

• Is 4 to 6 epithelial cells in urine normal?

Yes, 4 to 6 epithelial cells per high power field (HPF) in urine is generally considered normal, as some shedding of epithelial cells from the urinary tract is expected. However, consistently higher levels may indicate infection, inflammation, or kidney issues, requiring further evaluation by a doctor.

• Are squamous epithelial cells in urine normal?

Yes, squamous epithelial cells are the most common and usually come from the urethra or external genital area. A small number is normal, but excessive amounts may indicate sample contamination.

• How do doctors interpret epithelial cells along with other urine parameters?

Doctors analyse epithelial cells along with RBCs, WBCs, pus cells, and protein levels to assess infections, inflammation, or kidney conditions.

• What is the treatment for 25-30 HPF pus cells in urine?

If pus cells in urine are 25-30 HPF, it may indicate a urinary tract infection (UTI), kidney infection, or other inflammatory condition. Treatment typically includes antibiotics based on a urine culture test, increased fluid intake, and pain relievers if needed. Consult a doctor for proper diagnosis and targeted treatment.

• What do occasional epithelial cells in urine mean?

Occasional epithelial cells in urine are usually normal and result from natural shedding of the urinary tract lining. However, if found in excess or with symptoms like burning or pain, further tests may be needed to rule out infection or inflammation.

• Do epithelial cells in urine indicate a serious condition?

Not always. A slight increase may be due to dehydration or improper sample collection. However, persistently high levels should be evaluated further.

• Are epithelial cells in urine common during pregnancy?

Yes, epithelial cells in urine are common during pregnancy due to hormonal changes and increased shedding from the urinary tract. However, high levels may indicate an infection or kidney issues, requiring medical evaluation.

• Can high epithelial cells in pregnancy indicate a UTI?

Yes, a high number of epithelial cells in urine during pregnancy may signal a urinary tract infection (UTI), which is common in pregnant women due to hormonal changes and pressure on the bladder. A doctor may recommend a urine culture and antibiotics if needed.