From the Guidelines
The presence of more than 10 epithelial cells (non-renal) in a urinalysis with no red blood cells suggests contamination of the urine sample rather than a true urinary tract infection or malignancy, as the recent AUA/SUFU guideline 1 does not indicate epithelial cells as a risk factor for genitourinary malignancy.
Key Points to Consider
- The recent AUA/SUFU guideline 1 focuses on the evaluation of microhematuria, emphasizing the importance of a detailed history, physical examination, and serum creatinine to assess risk factors for genitourinary malignancy.
- The guideline introduces the AUA/SUFU Microhematuria Risk Stratification System 2025, which categorizes patients into low, intermediate, and high risk of malignancy based on factors such as age, smoking history, and degree of hematuria.
- However, the presence of epithelial cells in the urine is not a criterion for risk stratification in this guideline, suggesting that it is not a significant factor in the evaluation of genitourinary malignancy.
Recommendations for Clinical Practice
- I recommend collecting a new, clean-catch midstream urine sample for repeat analysis to rule out contamination.
- To obtain a proper sample, the patient should thoroughly clean the genital area, begin urinating into the toilet, then collect the middle portion of the urine stream in the sterile container, and finish urinating into the toilet.
- Epithelial cells in urine typically come from the skin, vagina, or urethra, and their presence in high numbers indicates that the sample was likely contaminated during collection.
- Without other signs of infection or malignancy, such as bacteria, white blood cells, or symptoms like dysuria or frequency, treatment is not indicated based on epithelial cells alone.
- If the repeat sample still shows similar findings but the patient has urinary symptoms, further evaluation including urine culture may be warranted to guide appropriate management, as suggested by the older study 1 on clinical policy for children younger than three years presenting to the emergency department with fever.
From the Research
Urinalysis Results
- The presence of epithelial cells in the urine with a count of >10, without any red blood cells (RBCs), may indicate a non-renal source of the epithelial cells 2.
- The absence of RBCs in the urine suggests that the epithelial cells are not likely to be from a renal source, such as a kidney stone or infection 2.
Possible Causes
- The presence of epithelial cells in the urine can be caused by a variety of factors, including contamination during the urine collection process, or a non-renal source such as the urethra or genital tract 2.
- The patient's symptoms and medical history should be taken into account to determine the cause of the epithelial cells in the urine 3, 4.
Further Evaluation
- A thorough medical history and physical examination should be performed to determine the cause of the epithelial cells in the urine 3, 4.
- Additional laboratory tests, such as a urine culture, may be necessary to rule out a urinary tract infection or other conditions 3, 4.
- Imaging studies, such as a renal ultrasound or computed tomography scan, may be necessary to evaluate the kidneys and urinary tract for any abnormalities 5.