Water quality in San Francisco Bay has been adversely affected by nitrogen loading from wastewater treatment plants (WWTPs) discharging around the periphery of the Bay. While there is documented use of zeolites and anammox bacteria in removing ammonia and possibly nitrate during wastewater treatment, there is little information available about the combined process. Though relatively large, zeolite beds have a finite ammonium adsorption potential and require periodic re-generation depending on the wastewater nitrogen loading. Use of anammox bacteria reactors for wastewater treatment have shown that ammonium (and to some degree, nitrate) can be successfully removed from the wastewater, but the reactors require careful attention to loading rates and internal redox conditions. Generally, their application has been limited to treatment of high-ammonia strength wastewater at relatively warm temperatures. Moreover, few studies are available describing commercial or full-scale application of these reactors. We briefly review the literature considering use of zeolites or anammox bacteria in wastewater treatment to set the stage for description of an integrated zeolite-anammox process used to remove both ammonium and nitrate without substrate regeneration from mainstream WWTP effluent or anaerobic digester filtrate at ambient temperatures.