The feasibility of using a two-stage autotrophic nitrogen removal process to treat sewage was examined in this study. The obtained results showed that total nitrogen (TN) could be efficiently removed by 88.38% when influent TN and chemical oxygen demand (COD) were 45.87 and 44.40 mg/L, respectively. In the first stage, nitritation was instantly achieved by the bioaugmentation strategy, and can be maintained under limited oxygen condition (below 0.2 mg/L). The ratio of nitrite to ammonium in the effluent of the nitritation reactor can be controlled at approximate 1.0 by adjusting aeration rate. In the second stage, anammox was realized in the upflow anaerobic sludge blanket (UASB) reactor, where the total nitrogen removal rate was 0.40 kg N m(-3) d(-1) under limited-substrate condition. Therefore, the organic matter in sewage can be firstly concentrated in biomass which could generate biogas (energy). Then, nitrogen in sewage could be removed in a two-stage autotrophic nitrogen removal process. (C) 2011 Elsevier Ltd. All rights reserved.