>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.
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