Macrophages are important immune cells involved in innate immunity, with significant heterogeneity and polarization. Macrophages can polarize into different phenotypes (mainly M1 and M2) under stimulation by various factors in the microenvironment, leading to different roles and functions. Macrophages play an important role in the pathophysiological mechanism of renal ischemia-reperfusion injury (RIRI). An excessive immune response will inevitably lead to tissue damage. M1 macrophages are pro-inflammatory cells involved in the clearance of pathogens, while M2-type macrophages have anti-inflammatory effects and participate in the repair and remodeling of renal tissue after RIRI. The balance between these macrophage phenotypes is thus an important factor affecting the outcome and treatment of RIRI. This review considers the pathophysiologic mechanism of macrophages in RIRI and the latest treatments from the perspective of macrophage polarization, with the aim of supporting further studies of the function of macrophage polarization in RIRI and adjusting the macrophage polarization process to improve RIRI treatment strategies.