The large majority of cases of renal failure are because of overdosing; which is easy to do in animals that weigh less than 10 pounds. The other high at risk group were cats with pre-existing kidney problems.
I called my vet and asked her why she was prescribing this drug as opposed to the buprenex, and she said that the metacam was going to manage his pain much better as opposed to the buprenex. I asked about the renal failure connected to overdosing in the oral suspension, and she explained the dosing procedure (he's only getting two doses that should manage his pain for the week). She repeated what I had read, which was that the at risk groups of cats were given large or long term doses or had pre-existing kidney problems. She said the bloodwork showed his kidneys were fine, and that she checked his urinalysis in October to confirm that. She also told me that she is more worried about him developing complications due poor pain management than she is with Bandit developing kidney problems. She said she has never had a cat have difficulty on metacam, even ones who are on more long term doses than Bandit.