The effects of surface water pretreatment on membrane fouling and the influence of these different fouling types on the rejection of 21 neutral, positively and negatively charged pharmaceuticals were investigated for two nanofiltration membranes. Untreated surface water was compared with surface water, pretreated with a fluidized anionic ion exchange and surface water, pretreated with ultrafiltration. Fouling the nanofiltration membranes with anionic ion exchange resin effluent, resulted in the deposition of a mainly colloidal fouling layer, with a rough morphology. Fouling the nanofiltration membranes with ultrafiltration permeate, resulted in the deposition of a smooth fouling layer, containing mainly natural organic matter. The fouling layer on the nanofiltration membranes, caused by the filtration of untreated surface water, was a combination of both colloids and natural organic matter. Rejection of pharmaceuticals varied the most for the membranes, fouled with the anionic ion exchange effluent, and variations in rejection were caused by a combination of cake-enhanced concentration polarisation and electrostatic (charge) effects. For the membranes, fouled with the other two water types, variations in rejection were smaller and were caused by a combination of steric and electrostatic effects. Changes in membrane surface hydrophobicity due to fouling, changed the extent of partitioning and thus the rejection of hydrophobic, as well as hydrophilic pharmaceuticals. (C) 2009 Elsevier B.V. All rights reserved.