In recent years, various technologies have been developed for the removal of nitrogen from wastewater that is rich in nitrogen but poor in organic carbon, such as the effluents from anaerobic digesters and from certain industries. These technologies have resulted in several patents. The core of these technologies is some of the processes and patents described in this paper: Aerobic denitrification, Sharon, Anammox, OLAND, CANON, NOx process, DEMON. More specifically, one of the first innovative options described for removing nitrogen include partial nitrification under aerobic conditions (partial Sharon process) followed by autotrophic anaerobic oxidation (Anammox process). The partial Sharon-Anammox process can be performed under alternating oxic and anoxic conditions in the same bioreactor or in two steps in two separate bioreactors. This overview focuses on the technical and biological aspects of these new types of treatment system, and compares them to other technologies. Given the fact that nitrification is a sensitive process, special attention is paid to conditions such as temperature, dissolved oxygen, hydraulic retention time, free ammonia, nitrous acid concentration, and pH. A discussion of the pros and cons of such treatment systems is also included since autotrophic nitrogen removal has advantages as well as drawbacks. The paper concludes with a discussion of future research that could improve these systems by enhancing performance and reducing costs.