Epithelial Cells in Urine: Normal Range, Causes, Test Results

Epithelial cells are the cells on the body's surface, such as the skin, urinary tract, blood vessels, and organs. They act as a protective barrier, stopping viruses from entering the body. Besides the protective function, epithelial cells perform other functions as well, such as:

1. Helps with sensory detection of taste, smell or sight as they transfer signals through the sensory nerve endings
2. Secretes hormones, enzymes, hormones, and fluids
3. Absorbs certain substances, such as nutrients from the food
4. Epithelial cells in the kidney excrete waste, and epithelial cells in the sweat glands excrete sweat
5. Filters blood, dirt, and particles
6. Allows selective diffusion of materials to pass through

Epithelial cells can be of different shapes, sizes, and appearances. However, depending on the origin, three types of epithelial cells are present in the urine. These types include:

1. Renal tubular epithelial cells: Also called renal cells, these are the most important epithelial cells. An increase in these cells in the urine may indicate a kidney disorder. 
2. Squamous epithelial cells: They are the largest epithelial cells in the human body and are found in the vagina and urethra. These types of cells are commonly found in female urine.
3. Transitional epithelial cells: Also called bladder cells, they are present between the male urethra and the renal pelvis. These types of cells are commonly present in older men.

Your body undergoes normal wear and tear. As a result, cells die and are removed from the body through various excretory methods, such as urine. Therefore, the presence of epithelial cells in urine in the normal range is possible. However, elevated levels are a cause of concern.

Elevated epithelial cells in urine may cause symptoms such as:

1. Pain or burning sensation while urination or sex
2. Frequent need to urinate
3. Blood in urine
4. Thick white discharge
5. Cloudy or smelly urine
6. Pain in the lower abdomen
7. Back pain
8. Soreness or itching in the vagina
9. Feeling tired or unwell

Epithelial cells in urine are usually not a cause of concern. However, if the amount of these cells in the urine exceeds the normal range, it may indicate an infection or a serious condition. Epithelial cells can be present in the urine due to several reasons, such as:

1. Specimen Contamination: Contamination while specimen collection is the most common cause of too many epithelial cells in the urine, especially in women.
   Contamination can occur due to using an unsterile collection cup or unclean genitals. To avoid specimen contamination, clean the genital area with a wet wipe. Urinate into the toilet to remove urethral bacteria before urinating into the collection cup. Submit the specimen immediately. 
2. Urinary Tract Infections (UTIs): The presence of epithelial cells in urine is mostly due to urinary tract infections. In such cases, microorganisms are also present. In some cases of UTIs, the urine will also have mucus strings.
   If a UTI is diagnosed, your doctor may also evaluate the number of leukocytes (white blood cells) in urine.  
3. Kidney problems: The presence of several tubular or columnar-shaped epithelial cells in urine may be due to a kidney problem. If most of these cells are columnar, it may indicate a severe kidney injury with a risk of decreased functioning.
   Other changes that may point towards kidney damage include creatinine and urea in the urine. 
4. Menopause: Women in the post-menopausal phase with low estrogen levels may also have many epithelial cells in the urine. However, this does not mean they are necessarily at a higher risk for disease.
   Women who suspect menopause should get their hormone levels checked. 
5. Physical trauma or irritation: Activities like catheterisation, vigorous sex, or injury to the urinary tract can lead to physical trauma or irritation. This results in the increased shedding of squamous epithelial cells. 
6. Bladder or urethral diseases: Certain diseases like bladder cancer, urethral cancer, and urethritis can cause increased shedding of epithelial cells into the urine.

Having more than normal epithelial cells in urine is not a good sign. Some people are at a higher risk of having epithelial cells in their urine than others.

While epithelial cells in urine can be caused due to several diseases, certain factors can increase the risk for elevated levels of these cells. You should talk to your healthcare provider if you have a higher risk of increased epithelial cells.

The risk factors of increased epithelial cells in urine include:

1. Kidney stones: Kidney damage or failure is a common complication of kidney stones. Kidney damage can cause an increase in the epithelial cells in urine. 
2. Weak immune system: A weak immune system can cause an infection to reach a more advanced stage. As a result, the symptoms of a UTI may appear, which causes an increase in the epithelial cells in urine.
3. Liver disease: People with autoimmune liver disease are prone to recurrent urinary tract infections, increasing the epithelial cells in the urine range. 
4. Diabetes: High blood glucose levels can increase the risk of developing UTIs since the body cannot fight the germs. 
5. High blood pressure: High blood pressure for prolonged periods can stop the kidneys from working correctly. As a result, kidney damage may cause epithelial cells in urine to increase. 
6. Family history of chronic kidney disease: People with a family history of chronic kidney disease are more prone to developing this condition. Chronic kidney disease is a common cause of higher than-normal epithelial cells in urine. 
7. Enlarged prostate: An enlarged prostate can place pressure and compress the urethra. It can cause urinary tract infections due to incomplete bladder emptying. 
8. Pregnancy: A higher count of epithelial cells in urine during pregnancy is normal since the woman’s body undergoes many changes. Furthermore, UTIs are common during pregnancy, which may result in elevated epithelial cells. 
9. Ethnicity: The presence of epithelial cells in urine is typical for people who are African, Asian, American Indian, and Hispanic.

Your doctor will order a urinalysis to measure the number of epithelial cells in urine. You may need this test if you experience symptoms such as pain when urinating, frequent urination, pain in the lower abdomen, and back pain.

You may also need the test if a visual or chemical urine test shows an elevated level of epithelial cells. The test is performed through the following steps:

1. The doctor or nurse will give you a sterile pad and container for urine collection and explain how to take the sample. 
2. You must use the pad to clean your genitals before urinating in the container. 
3. Let a small amount of urine flow before collecting the sample midstream. 
4. Do not touch the inside of the sterilised container with your hands or genitals. 
5. The urine specimen is sent to a lab and analysed for different substances. 

Understanding the Urine Test Results

It is essential to know the epithelial cells in urine range to understand what is considered normal and excessive. A small number of epithelial cells are normally present in your urine. The count of epithelial cells present in urine is measured through a urine test. 

Normal epithelial cells in urine remain constant for people of all age groups and gender. The optimum level of epithelial cells in a urine sample is about 15 to 20 squamous epithelial cells per HPF (high power field). 

The results of the urinalysis may show a few, moderate, or many epithelial cells in urine. But what do epithelial cells in urine mean? If your test result is few, there are normal epithelial cells in the urine.

However, a result of moderate or more may indicate a medical condition, such as a yeast or urinary tract infection, liver or kidney disease, or certain kinds of cancer.

Urinary tract infections and kidney diseases are two of the most common causes of elevated epithelial cells in urine. However, there are specific ways in which you can prevent these conditions, such as:

1. Staying hydrated: Drink several glasses of water daily to prevent diseases that cause high levels of epithelial cells in urine. 
2. Cranberry: They include a chemical that guards against bacteria attaching to the uterus lining. Drinking cranberry juice or eating cranberries helps promote kidney health and lower the risk of developing UTIs. However, the efficacy of cranberries is still debatable. 
3. Urinate as soon as you feel the urge: Holding urine for longer periods increases the risk of infection. Therefore, you should immediately urinate when you feel the urge. 
4. Urinate after sexual intercourse: Both men and women must urinate after sex. It flushes out any bacteria that was introduced into the urethra. 
5. Wipe carefully: You must wipe from front to back after urination or a bowel movement, as it prevents the spread of bacteria to your urethra. 
6. Do not use products in the genital area: Products like deodorant sprays or douches for the genital area can increase irritation and infection risk. 
7. Wear loose-fitting clothes: Breathable clothes allow the area around the urethra to stay dry, limiting bacterial growth. 

Lifestyle Changes to Manage Abnormal Epithelial Cells in Urine

The doctor may advise some lifestyle changes to help manage the abnormal levels of epithelial cells in urine. Some of these changes include:

1. Reduce the intake of foods high in cholesterol
2. Cut back on salt
3. Limit alcohol
4. Quit smoking
5. Engage in physical activity
6. Lose weight
7. Drink more water
8. Eat a heart-healthy diet

While elevated epithelial cells present in the urine may indicate serious conditions, it is possible to reduce the number of these cells through different treatments.

Wondering how to reduce epithelial cells in urine? The treatment approach depends on the cause of high levels of epithelial cells. The following are the treatment methods for various underlying causes of epithelial cells in urine:

1. Urinary Tract Infections: Bacterial UTIs can be treated with antibiotics, such as Amoxicillin, Nitrofurantoin, etc. Fungal UTIs can be treated with antifungal. Viral UTIs can be treated with antivirals. 
2. Yeast infections: You can treat a yeast infection by taking antifungal medications, available as creams, ointments, and tablets, for three to seven days. 
3. Kidney disease: To treat kidney diseases, it is important to manage related diseases like blood pressure, blood sugar, and blood cholesterol levels.
   The doctor will prescribe blood pressure medicine to manage blood pressure and slow the progression of the disease. Blood sugar is controlled through insulin injections. Cholesterol levels can be kept in check through a healthy diet, including fruits, vegetables, and grains. 
4. Liver disease: The treatment for liver disease depends on its type. Certain liver problems can be treated with lifestyle modifications like avoiding alcohol, increasing fibre intake, and limiting fat and calories.
   Some other liver diseases may be treated with medications for viral infections. A liver transplant is usually the best treatment option when the liver problem progresses to liver failure. 
5. Bladder and urethral cancer: Surgery, radiation therapy, and chemotherapy are the most commonly used methods for treating bladder and urethral cancers.

Urinalysis is a simple and easy test that can provide vast information about your health. At-home urine tests are quick to perform. The test can help catch an infection early and save time and money.

If the results of a urine test indicate more than normal epithelial cells in the urine, you should talk to a doctor about what this means for your health. You should also consult a healthcare professional if you experience the following symptoms:

1. Fever
2. Frequent, painful urination
3. Pain in the lower abdomen
4. Back pain
5. Blood in the urine

Epithelial cells on the skin, urinary tract, and blood vessels are protective barriers preventing viruses from entering the body. Normally, epithelial cells in urine range from 15-20 squamous epithelial cells per HPF. However, exceeding this normal range may indicate a serious condition, such as UTIs or kidney disease. Urinalysis is the test doctors use to measure the levels of various substances in your urine. 

If you are experiencing symptoms of epithelial cells in urine or have other concerns about your health, it is essential to consult your healthcare professional. They can tell if you have an underlying condition that needs treatment by conducting further testing. The medical professionals at HexaHealth will help you with free consultations regarding your concerns. Moreover, we will connect you with the best doctors if further treatment is required. Contact a HexaHealth expert TODAY!

Suggested Reads

To read more on changes in urine, visit the following links:

• Dark Yellow Urine Causes
• Bilirubin in Urine
• RBC in Urine
• Pus Cells in Urine
• Early Pregnancy Urine Colour

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