The granulation of anammox sludge plays an important role in the high nitrogen removal performance of the anammox reactor. In this study, anaerobic granular sludge was selected as the seeding sludge to start up anammox reactor in order to directly obtain anammox granules. Results showed that the anammox UASB reactor was successfully started up by inoculating anaerobic granular sludge, with substrate capacity of 4435.2 mg/(L·d) and average ammonium and nitrite removal efficiency of 90.36% and 93.29%, respectively. During the start-up course, the granular sludge initially disintegrated and then reaggregated and turned red, suggesting the high anammox performance. Zn-Fe precipitation was observed on the surface of granules during the operation by SEM-EDS, which would impose inhibition to the anammox activity of the granules. Accordingly, it is suggested to relatively reduce the trace metals concentrations, of Fe and Zn in the conventional medium. The findings of this study are expected to be used for a shorter start-up and more stable operation of anammox system.