A five-stage centrifugal pump is utilized to investigate the interstage flow characteristics of the multistage centrifugal pump as turbine (PAT). The simulation results of performance are verified by comparing with the experimental results. Owing to the distinct structural attributes, significant differences in flow occur between the first stage and the other stages of the multistage PAT. To enhance the understanding of these disparities and explore their repercussions, this study focuses on analyzing the flow within the impellers in the first and second stages by a deterministic analysis. The main conclusions are as follows: The discrepancies in the inflow conditions are the major reason for the dissimilarities in the flow of impellers between stages. The impact loss generated by the misalignment between the positive guide vane outlet angle and the impeller inlet angle leads to flow deviation between impeller passages and affects the internal flow pattern. The unsteadiness under low flow rates is mostly produced by the spatial gradient of the blade-to-blade nonuniformities, which is relevant to the relative position between blades and the positive guide vanes. At high flow rates, especially in the second-stage impeller, the pure unsteady term is the primary cause of flow unsteadiness as a result of the flow separation induced by interactions between the blades and the positive guide vanes. This study can provide some references for the practical operation and performance optimization of the multistage PATs in the future.