Paediatric nephrology at the University Hospital of the West Indies has grown over the last five decades into an established paediatric subspecialty offering to Jamaica and other Caribbean territories the benefit of paediatricians with training and exposure in this field. Dissemination of information to medical practitioners within the island has reduced mortality and morbidity associated with potentially treatable atypical renal disease. Clear investigative guidelines for urinary tract infection have made earlier diagnosis of urological malformations possible. Patterns of glomerular disease in Jamaican children have now been aetiologically and histologically documented. Children with chronic kidney disease now have clear management guidelines and the possibility of renal replacement therapy. Future goals include community education about renal disease and the development of a paediatric dialysis and transplantation unit.