BackgroundAccess to care for children with kidney disease is limited in less well-resourced regions of the world and paediatric nephrology (PN) workforce development with good practical skills is critical.MethodsRetrospective review of a PN training program and trainee feedback from 1999 to 2021, based at Red Cross War Memorial Children’s Hospital (RCWMCH), University of Cape Town.ResultsA regionally appropriate 1–2-year training program enrolled 38 fellows with an initial 100% return rate to their country of origin. Program funding included fellowships from the International Pediatric Nephrology Association (IPNA), International Society of Nephrology (ISN), International Society of Peritoneal Dialysis (ISPD), and the African Paediatric Fellowship Program (APFP). Fellows were trained on both in- and out-patient management of infants and children with kidney disorders. “Hands-on skills” training included examination, diagnosis and management skills, practical insertion of peritoneal dialysis catheters for management of acute kidney injury and kidney biopsies. Of 16 trainees who completed > 1 year of training, 14 (88%) successfully completed subspecialty exams and 9 (56%) completed a master’s degree with a research component. PN fellows reported that their training was appropriate and enabled them to make a difference in their respective communities.ConclusionsThis training program has successfully equipped African physicians with the requisite knowledge and skills to provide PN services in resource-constrained areas for children with kidney disease. The provision of funding from multiple organizations committed to paediatric kidney disease has contributed to the success of the program, along with the fellows’ commitment to build PN healthcare capacity in Africa.Graphical abstractA higher resolution version of the Graphical abstract is available asSupplementary informationSupplementary InformationThe online version contains supplementary material available at 10.1007/s00467-023-06022-9.