Epithelial Cells in Urine · high result
Epithelial cells in urine: what a high count means, squamous versus renal cells and when to repeat
Short answer
A high epithelial cell count on urine microscopy is almost always squamous cells — large cells from the skin, urethra and vagina that mean the sample was not a clean midstream catch. They are harmless, but they bring white cells and bacteria that can mimic an infection, so an abnormal urinalysis with many squamous cells is repeated rather than treated. Transitional cells in clusters and renal tubular cells are the types that point to the bladder lining or the kidney itself.
Medically reviewed by Youmna DiStefano, MD · Last reviewed November 2026
When does this result need same-day care?
- Renal tubular cells or granular casts with a rapidly rising creatinine, very little urine or recent shock, sepsis or contrast — same-day assessment for acute kidney injury
- Visible blood with clusters of abnormal cells, or inability to pass urine — same-day urology assessment
What is the normal range for Epithelial Cells in Urine?
- age 18+, squamous; microscopy: 0 – 5 /hpf
Many squamous cells almost always mean the sample picked up skin cells from the genital area — a contaminated, non-clean-catch specimen worth repeating; transitional cells in number suggest bladder irritation; renal tubular cells point to kidney tubule injury.
Full reference table, citations and testing options: Epithelial Cells in Urine biomarker page.
What are the common causes of high Epithelial Cells in Urine?
- A non-midstream or poorly cleaned sample — the most common cause of 'moderate' or 'many' squamous epithelial cells
- Collection during menstruation or with a vaginal discharge; vaginitis; in men, an unretracted foreskin
- A recent catheter or cystoscopy, kidney stones, urinary infection and bladder inflammation — transitional (urothelial) cells
- Clusters of transitional cells, atypical cells or transitional cells with persistent blood — urothelial (bladder or upper tract) cancer until excluded, especially in smokers and over 50
- Acute tubular necrosis after shock, sepsis or contrast; nephrotoxic drugs (aminoglycosides, cisplatin, NSAIDs) — renal tubular epithelial cells, often with granular casts
- Acute interstitial nephritis, glomerulonephritis, viral infection of the kidney (CMV, BK virus in transplant recipients) and transplant rejection — renal tubular cells
- Nephrotic syndrome — renal tubular cells filled with fat (oval fat bodies) and fatty casts
- Heavy-metal exposure and other tubular toxins
What symptoms go with high Epithelial Cells in Urine?
- None — squamous cells are a finding about the sample, not the person
- Burning, frequency and urgency if there is a genuine infection alongside
- Blood in the urine, irritative bladder symptoms or pelvic pain with transitional cells of concern
- Reduced urine output, swelling or a rising creatinine when renal tubular cells reflect kidney injury
What do clinicians usually check next?
- Many squamous cells: repeat the urinalysis as a careful clean-catch midstream sample — hands washed, area cleaned, first part of the stream discarded — with a culture only if infection is the question; if the repeat is clean and normal, nothing more
- Do not start antibiotics on a contaminated sample — a culture from it grows mixed skin and vaginal organisms that are not an infection
- Transitional cells: a repeat urinalysis with microscopy; urine cytology and a urology referral for cystoscopy if the cells are clustered or atypical, if there is blood in the urine, or in a smoker or anyone over 50 with urinary symptoms
- Renal tubular cells: serum creatinine and eGFR, a urine albumin-to-creatinine ratio, a review of casts on the same microscopy, and a medication review for nephrotoxins
- A nephrology referral when kidney function is reduced or falling, or when tubular cells come with granular casts, protein or blood
How do you recheck Epithelial Cells in Urine?
Prices are cash-pay; every order adds one $6 lab processing fee. Physician authorization is included; no insurance or referral needed.
| Test or panel | Type | Price | Fasting | Results |
|---|---|---|---|---|
| Kidney Health Panel | Panel · 4 tests | $64.99 | Yes | 2–4 business days |
| Early Pregnancy Panel | Panel · 9 tests | $249.99 | No | 3–5 business days |
| Men's Total Body Advanced Panel | Panel · 65 tests | $999.99 | Yes | 5–10 business days |
| Complete Urinalysis Test | Test · 14 biomarkers | $17.99 | No | 1–3 business days |
Common questions
What does 'many squamous epithelial cells' in urine mean?
The sample picked up cells from the skin, urethra or vagina — it was not a clean midstream catch. The cells are harmless, but they come with white cells and bacteria that can make the leukocyte esterase, bacteria count and culture look like an infection when there is none. If anything else on the report is abnormal or you have symptoms, repeat the test with careful clean-catch technique before acting on it.
How many epithelial cells in urine is too many?
More than about 5 squamous cells per high-power field — reported as 'moderate' or 'many' — marks a contaminated sample; some laboratories accept more in women. Occasional transitional cells are normal. Renal tubular epithelial cells should be absent or rare, and more than about 15 per ten high-power fields suggests injury to the kidney tubules.
Are epithelial cells in urine a sign of cancer?
Squamous cells are not. Transitional cells can be when they appear in clusters, look atypical, or come with persistent blood in the urine — particularly in a smoker or someone over 50 — and in that setting urine cytology and cystoscopy are done to exclude bladder cancer. Most transitional cells are from a catheter, a stone or simple bladder irritation.
Do epithelial cells in urine mean a UTI?
Not by themselves. Squamous cells usually indicate contamination, and the white cells and bacteria that accompany them are from the skin and vagina rather than the bladder. A urinary infection is diagnosed by symptoms with white cells, nitrite or a positive culture on a properly collected sample, which is why a repeat clean catch is the right next step.
Educational content, not a diagnosis. Lab results are one input; a clinician interprets them with your history and exam.