Squamous Epithelial Cells

Urine
Optimal Result: 0 - 3 HPF.

>10 x 106/L squamous epithelial cells indicate skin/mucosal contamination of the sample.

What are epithelial cells?

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:

→ Help with sensory detection of taste, smell or sight as they transfer signals through the sensory nerve endings

→ Secrete hormones, enzymes, hormones, and fluids

→ Absorb certain substances, such as nutrients from the food

→ Epithelial cells in the kidney excrete waste, and epithelial cells in the sweat glands excrete sweat

→ Filter blood, dirt, and particles

→ Allow selective diffusion of materials to pass through

In general, epithelial cells act as a barrier between the outside and inside of your body, and help protect your body from viruses.

What are squamous epithelial cells?

Squamous epithelial cells are large and irregularly shaped, with a small nucleus and fine granular cytoplasm; their presence suggests contamination

What are normal levels of epithelial cells in urine?

It is normal to have a few epithelial cells eliminated in the urine due to the normal shedding of cells along the urinary tract. However, many epithelial cells in urine may indicate an underlying health condition.

What are the different types of epithelial cells?

Epithelial cells are cells that come from surfaces of your body, such as your skin, blood vessels, urinary tract, or organs. They serve as a barrier between the inside and outside of your body, and protect it from viruses. A small number of epithelial cells in your urine is normal. A large number may be a sign of infection, kidney disease, or another serious medical condition. For that reason, your doctor may order a urine test or urinalysis to view your urine under a microscope. 

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:

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.

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. 

The presence of renal tubule cells indicates significant renal pathology.

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.

The presence of transitional epithelial cells is normal. These cells are smaller and rounder than squamous cells, and they have larger nuclei.

What is the “clean catch” method?

The clean catch method of obtaining a urine sample usually prevents squamous epithelial cells from turning up in the urine. When using the clean catch technique, you’ll be given a sterilizing cloth to wipe the area around the vagina or penis before giving your urine sample. This prevents contaminants from your skin, like epithelial cells, from showing up in your sample.

References:

Kurn H, Daly DT. Histology, Epithelial Cell. 2023 Feb 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32644489.

Mohr NM, Harland KK, Crabb V, Mutnick R, Baumgartner D, Spinosi S, Haarstad M, Ahmed A, Schweizer M, Faine B. Urinary Squamous Epithelial Cells Do Not Accurately Predict Urine Culture Contamination, but May Predict Urinalysis Performance in Predicting Bacteriuria. Acad Emerg Med. 2016 Mar;23(3):323-30. doi: 10.1111/acem.12894. Epub 2016 Feb 17. PMID: 26782662.

Maher PJ, Jablonowski KD, Richardson LD. Squamous epithelial cell presence reduces accuracy of urinalysis for prediction of positive urine cultures. Am J Emerg Med. 2020 Jul;38(7):1384-1388. doi: 10.1016/j.ajem.2019.11.024. Epub 2019 Nov 28. PMID: 31843330.

Walter FG, Gibly RL, Knopp RK, Roe DJ. Squamous cells as predictors of bacterial contamination in urine samples. Ann Emerg Med. 1998 Apr;31(4):455-8. doi: 10.1016/s0196-0644(98)70253-7. PMID: 9546013.

Chen A, Caron A, Jackson NJ, Kanji F, Kuhlmann P, Le CH, Eilber KS, Anger JT, Ackerman AL. Defining Properly Collected Urine: Thresholds to Improve the Accuracy of Urinalysis for Microscopic Hematuria Evaluation in Women. J Urol. 2022 Feb;207(2):385-391. doi: 10.1097/JU.0000000000002200. Epub 2021 Sep 21. PMID: 34544262.

Poloni JAT, de Oliveira Vieira A, Dos Santos CRM, Simundic AM, Rotta LN. Survey on reporting of epithelial cells in urine sediment as part of external quality assessment programs in Brazilian laboratories. Biochem Med (Zagreb). 2021 Jun 15;31(2):020711. doi: 10.11613/BM.2021.020711. PMID: 34140834; PMCID: PMC8183119.

Owens CL, Ali SZ. Atypical squamous cells in exfoliative urinary cytology: clinicopathologic correlates. Diagn Cytopathol. 2005 Dec;33(6):394-8. doi: 10.1002/dc.20344. PMID: 16299739.

Regeniter A, Haenni V, Risch L, Köchli HP, Colombo JP, Frei R, Huber AR. Urine analysis performed by flow cytometry: reference range determination and comparison to morphological findings, dipstick chemistry and bacterial culture results--a multicenter study. Clin Nephrol. 2001 May;55(5):384-92. PMID: 11393384.

What does it mean if your Squamous Epithelial Cells result is too high?

If there are squamous epithelial cells in your urine, it may mean your sample was contaminated. This means that the sample contains cells from another part of the body. This can happen if you do not clean your genital area well enough when collecting your urine sample with the clean catch method.

The normal range of squamous epithelial cells in urine is typically zero to five squamous epithelial cells per high-power field (HPF). Typical diagnostic ranges fall into either few, moderate, or many but can also be measured in number. A normal range is less than 15 to 20 per HPF; therefore, more than 15 to 20 squamous epithelial cells per HPF indicate contamination in the urine sample.

More than five squamous epithelial cells in a single field of view can be considered an increased number that may indicate an infection or other health condition. If the number of squamous epithelial cells present is outside the normal range, you should consult a doctor to determine the underlying cause.

However, the normal range of squamous epithelial cells in urine may vary between laboratories and can be influenced by various factors, such as age, sex, and overall health. It is always best to consult a healthcare professional for an accurate interpretation of urine test results.

A moderate amount of squamous epithelial cells in the urine is not necessarily a cause for concern. However, if the number of these cells is consistently high or there are other signs of a urinary tract infection, further investigation and treatment may be necessary.

Squamous epithelial cells in urine may indicate the presence of an underlying health condition, but they do not necessarily indicate cancer. Squamous epithelial cells are flat, scale-like cells that are normally found in the outer layer of the skin and lining of certain organs, such as the mouth and vagina. When these cells are present in urine, it may indicate that they have been shed from an abnormal site, such as the bladder or urethra.

In some cases, the presence of squamous epithelial cells in urine may signify a bladder or urethral infection, irritation, or injury. However, other conditions, such as bladder or urethral cancer, can also cause these cells to be present in the urine. A cancer diagnosis cannot be made based on the presence of squamous epithelial cells in urine alone. Additional tests, such as a biopsy, a CT scan, or an MRI, may be necessary to determine the underlying cause and make a definitive diagnosis. Consult a healthcare provider if you are concerned about the presence of squamous epithelial cells in your urine.

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:

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. 

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.

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. 

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.

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.

Menopause: Women in the postmenopausal 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. 

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.

Bladder or urethral diseases: Certain diseases like bladder cancer, urethral cancer, and urethritis can cause increased shedding of epithelial cells into the urine.

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.

Liver disease: People with autoimmune liver disease are prone to recurrent urinary tract infections, increasing the epithelial cells in the urine range. 

Diabetes: High blood glucose levels can increase the risk of developing UTIs since the body cannot fight the germs. 

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.

Enlarged prostate: An enlarged prostate can place pressure and compress the urethra. It can cause urinary tract infections due to incomplete bladder emptying.

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.

Ethnicity: The presence of epithelial cells in urine is typical for people who are African, Asian, American Indian, and Hispanic.

Elevated epithelial cells in urine may cause symptoms such as:

→ Pain or burning sensation while urination or sex

→ Frequent need to urinate

→ Blood in urine

→ Thick white discharge

→ Cloudy or smelly urine

→ Pain in the lower abdomen

→ Back pain

→ Soreness or itching in the vagina

→ Feeling tired or unwell

How to prevent elevated epithelial cells in urine?

If there are squamous epithelial cells in your urine, it may mean your sample was contaminated. This means that the sample contains cells from another part of the body. This can happen if you do not clean your genital area well enough when collecting your urine sample with the clean catch method.

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:

Staying hydrated: Drink several glasses of water daily to prevent diseases that cause high levels of epithelial cells in urine. 

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. 

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.

Urinate after sexual intercourse: Both men and women must urinate after sex. It flushes out any bacteria that was introduced into the urethra.

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. 

Do not use products in the genital area: Products like deodorant sprays or douches for the genital area can increase irritation and infection risk.

Wear loose-fitting clothes: Breathable clothes allow the area around the urethra to stay dry, limiting bacterial growth. 

How to treat increased squamous epithelial cells?

Treatment of excess squamous epithelial cells in urine depends on the underlying cause. There are several treatment options for excess squamous epithelial cells in the urine, including the following:

Antibiotics: May be prescribed to treat an infection, which can cause an increase in squamous epithelial cells in the urine.

Hydration: Increasing fluid intake can help flush out excess squamous epithelial cells in the urine.

Avoiding irritants: Avoiding harsh soaps, bubble baths, and spermicidal products can reduce the amount of squamous epithelial cells in the urine.

Medical procedures: In some cases, medical procedures such as a bladder wash or bladder irrigation may be performed to remove excess squamous epithelial cells from the bladder.

Surgery: In severe cases, surgery may be necessary to remove any underlying conditions that increase the squamous epithelial cells in the urine.

If the blockage occurs due to a tumor, treatment options may include surgery, radiation therapy, chemotherapy, and immunotherapy. Your doctor will assess your condition and recommend the best treatment option. Seek medical advice for proper diagnosis and treatment of this condition.

Treatment will depend on the cause of the abnormal number of epithelial cells. Most UTIs are bacterial and can be treated with an antibiotic. Drinking more water can also speed healing. For viral UTIs, doctors may prescribe medication called antivirals.

Treatment for kidney disease means managing the underlying cause of the disease, including blood pressure, blood sugar, and cholesterol levels. Your doctor may prescribe a blood pressure medication to slow the progression of the disease or preserve kidney function, even if you don’t have high blood pressure. Healthy dietary and lifestyle changes are also important.

Drinking cranberry juice or eating cranberries may help lower the risk of developing UTIs. Cranberries contain a chemical that may guard against bacteria attaching to the lining of your bladder. However, there’s still debate about this remedy’s efficacy in the medical community.

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